RESPIRATORY SYNCYTIAL VIRUS-INFECTIONS IN PEDIATRIC RENAL-TRANSPLANT RECIPIENTS

Immunocompromised patients are considered at increased risk from respi ratory syncytial virus (RSV) infection. We examined the incidence and outcome of RSV infection in pediatric renal transplant (Tx) recipients on chronic immunosuppressive therapy. Of 173 recipients transplanted between November 1985 and April 1993, 5 (3%) developed RSV infection ( age range 11-39 months). Initial immunosuppression included prednisone , azathioprine, cyclosporine, and polyclonal antibody therapy. Time fr om Tx to onset of RSV infection was 1 day to 7 months. Symptoms includ ed rhinorrhea, cough, tachypnea, retractions, fever, wheezing, and abn ormal chest X-ray. Treatment included bronchodilator therapy, bronchia l drainage, ribavirin, and mist tent. Azathioprine was transiently wit hheld for leukopenia during treatment in 2 recipients. Three recipient s developed biopsy-proven acute rejection during (n=2) or immediately following (n=1) RSV infection; al responded to corticosteroid treatmen t. RSV infection is not commonly diagnosed in pediatric renal Tx recip ients, The course of RSV infection in our patients did not differ from that reported in normal children. The possible association between RS V and acute rejection warrants further observation. When diagnosed ear ly, RSV infection does not appear to be associated with increased mort ality in pediatric renal Tx recipients. Larger numbers of recipients n eed to be studied to confirm these results.