#54 Morbidity and Mortality Associated with Respiratory Syncytial Virus (RSV) Among Pediatric Solid Organ Transplant (SOT) Recipients: Preliminary Results from a Multi-Site U.S. Study.

Abstract

Abstract Background RSV is the most common lower respiratory tract infection (LRTI) among children. Serious adverse outcomes are more likely among immunocompromised patients, including progression to pneumonia, respiratory failure, and increased mortality rates. We present interim analyses results from a secondary data use multi-site study to characterize the morbidity and mortality associated with RSV infection among pediatric SOT patients. Method Pediatric (< 18 years old at transplant) SOT recipients from 10 U.S. transplant centers from the Pediatric Infectious Diseases Transplant Network (PIDTRAN) who underwent SOT between 2010 and 2019 and were RSV positive within 365 days of SOT were identified from medical records. Demographics, underlying condition, and clinical characteristics were abstracted and entered in an electronic REDCap survey. Descriptive statistics were used to characterize the clinical course and outcomes of RSV infection. Results In total, 40 SOT patients were eligible for analysis with 40 (93%) reporting 1 case of RSV within 365 days of transplant and 3 (7%) reported 2 episodes resulting in 43 RSV episodes. Over half (24, 60%) were male, 24 (60%) were white/Caucasian, with a median age of 2 years at the time of RSV diagnosis. The majority received 1 SOT (80%) prior to RSV diagnosis. The most common transplanted organ was liver 17 (42%) followed by heart 14 (36%) and kidney 9 (22%). Among the 43 episodes reported, almost half (46.5%) were diagnosed with LRTI at the time of RSV diagnosis and 29 (67.4%) required hospitalization. Among the 43 episodes, none received palivizumab and 1 (2.3%) received IVIG in the 4 weeks prior to RSV diagnosis. Nearly half (21, 48.8%) received oxygen support at least 4 hours per day (at least one day) with 3 (15%) requiring ventilator support. Only 2 (5%) were treated with ribavirin while 3 (7%) received IVIG within 28 days for the treatment of RSV. None received palivizumab within 28 days of diagnosis for RSV treatment. Among those who initially presented with upper respiratory tract infection, 2 (10%) progressed to LRTI after initial diagnosis of a URTI. One (2.4%) death related to RSV was reported. Conclusion Preliminary results from this continuing multi-site study demonstrate RSV is an ongoing concern among SOT recipients with approximately half developing LRTI and two thirds requiring hospitalization. These data help our understanding of RSV infections in this population and inform future prospective study designs to better define RSV risk as well as help address optimal prophylaxis and treatment strategies for SOT recipients at risk for severe illness.