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Observational Study
. 2020 Dec;22(6):e13422.
doi: 10.1111/tid.13422. Epub 2020 Aug 2.

Epidemiology and persistence of rhinovirus in pediatric lung transplantation

Evan Ammerman  1 , Stuart C Sweet  2 , Gregory A Storch  2 , Richard S Buller  2 , Sheila Mason  2 , Carol Conrad  3 , Don Hayes Jr  4 , Albert Faro  2   5 , Samuel B Goldfarb  6 , Ernestina Melicoff  7 , Marc Schecter  1 , Gary Visner  8 , Peter S Heeger  9 , Thalachallour Mohanakumar  10 , Nikki Williams  11 , Lara Danziger-Isakov  1
Affiliations
Observational Study

Epidemiology and persistence of rhinovirus in pediatric lung transplantation

Evan Ammerman et al. Transpl Infect Dis. 2020 Dec.

Abstract

Background: Infection with rhinovirus (HRV) occurs following pediatric lung transplantation. Prospective studies documenting frequencies, persistence, and progression of HRV in this at-risk population are lacking.

Methods: In the Clinical Trials in Organ Transplant in Children prospective observational study, we followed 61 lung transplant recipients for 2 years. We quantified molecular subtypes of HRV in serially collected nasopharyngeal (NP) and bronchoalveolar lavage (BAL) samples and correlated them with clinical characteristics.

Results: We identified 135 community-acquired respiratory infections (CARV) from 397 BAL and 480 NP samples. We detected 93 HRV events in 42 (68.8%) patients, 22 of which (23.4%) were symptomatic. HRV events were contiguous with different genotypes identified in 23 cases, but symptoms were not preferentially associated with any particular species. Nine (9.7%) HRV events persisted over multiple successive samples for a median of 36 days (range 18-408 days). Three persistent HRV were symptomatic. When we serially measured forced expiratory volume in one second (FEV1) in 23 subjects with events, we did not observe significant decreases in lung function over 12 months post-HRV.

Conclusion: In conjunction with our previous reports, our prospectively collected data indicate that molecularly heterogeneous HRV infections occur commonly following pediatric lung transplantation, but these infections do not negatively impact clinical outcomes.

Keywords: community-acquired respiratory virus (CARV); forced expiratory volume (FEV1); human rhinovirus (HRV); lung transplantation; pediatrics.

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Conflict of interest statement

Disclosure:

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1:
Figure 1:
Seasonality of CARV events separated by HRV (right) and non-HRV (left) events. Seasons are divided by month, with Spring March 1 – May 31, Summer June 1 – August 31, Autumn September 1 – November 30, and Winter December 1 – February 28. hMPV = human metapneumovirus; PIV = parainfluenza virus; RSV = respiratory syncytial virus; HRV = human rhinovirus.
Figure 2:
Figure 2:
Human rhinovirus (HRV) event occurrence post-transplant, presented as the number of new events per month.
Figure 3:
Figure 3:
Positivity of samples for all CARV events (left) and HRV-only events (right). NP and BAL samples are positive (+) or negative (−) when paired, or indicated as not done (N/D) when no paired sample was performed. HRV = human rhinovirus; NP = nasopharyngeal swab; BAL = bronchoalveolar lavage.
Figure 4:
Figure 4:
Forced expiratory volume (FEV1) z-scores in patients with and without HRV events. Days in patients with HRV events are relative to the time of the HRV event at day 0 and in patients without HRV event are relative to transplant at day 0.
See this image and copyright information in PMC

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