ADENOVIRUS INFECTION IN THE LUNG RESULTS IN GRAFT FAILURE AFTER LUNG TRANSPLANTATION

Objectives: Our goal was to examine the relationship between viral pne umonia and outcome ire pediatric patients undergoing lung or heart-lun g transplantation. Methods: Prospective surveillance for common respir atory viruses of childhood was performed in all patients undergoing lu ng or heart-lung transplantation. Specimens were examined for the pres ence of replicating virus (by culture), viral genome (by polymerase ch ain reaction), and viral antigen (by immunofluorescence and immunohist ochemical staining). The relationship between viral infection and outc ome was examined. Results: Sixteen patients underwent 19 transplants d uring the study period, with follow-up of 1 to 26 months. Virus was id entified in the transplanted lung in 29 instances; adenovirus was iden tified most commonly (8/16 patients) and had the greatest impact on ou tcome. In 2 patients with early, fulminant infection, adenovirus was a lso identified in the donor. Adenovirus was significantly associated w ith respiratory failure leading to death or graft loss and with the hi stologic diagnosis of obliterative bronchiolitis (P less than or equal to.002 in each case), Conclusions: Adenovirus infection in the transp lanted lung is significantly associated with graft failure, histologic obliterative bronchiolitis, and death. Health care personnel and fami lies must be vigilant in preventing exposure of transplant recipients to this virus. Availability of a rapid and reliable test for adenoviru s in donors and recipients would have an impact on management and coul d improve outcome for pediatric lung recipients.