Pediatric lung transplantation and CMV pneumonitis: a ten year experience

Abstract

Cytomegalovirus (CMV) infection remains an important source of morbidity after solid organ transplantation. To understand the impact of CMV pneumonitis in pediatric lung transplant recipients, we conducted a prospective study of 194 pediatric patients receiving 218 lung transplants. Medical records of pediatric patients undergoing transplantation at Saint Louis Children’s Hospital between 1990 and September 2000 were reviewed after Institutional Review Board approval. Data was analyzed using survival analysis. 194 patients underwent primary transplants and 24 were re-transplants. 86 male & 108 female patients were tracked for an average of 2.7 years (range: 1 day − 9.7 years). 46.6% had cystic fibrosis, 26.9% had pulmonary hypertension and 26.4% had other pulmonary diseases. All CMV-seropositive recipients (R+) and all CMV-seronegative recipients who received CMV-seropositive organs (R-/D+) were treated with gancyclovir prophylaxis for a total of six weeks post transplant. Histologic evidence of CMV pneumonitis was observed in 32 patients (16.5%). Survival analysis identified that the only risk factors for CMV pneumonitis were CMV donor and recipient seropositive status. R-/D+ were at 6.1 times (95% confidence interval (CI): 2.0-18.1) increased risk of developing subsequent CMV. The increase in risk was 3.2 (95% CI: 0.9-11.0) for D+/R+. No increased risk was found among R+/D-: (relative risk=2.3; 95% CI: 0.6-9.2). Sex, age , primary diagnosis and a second transplant were not risk factors for development of CMV pneumonitis. Of all patients with CMV pneumonitis, 7 subsequently developed post-transplant lymphoproliferative disease (PTLD) and 11 developed bronchiolitis obliterans (BO).CMV pneumonitis did not increase the risk of PTLD (relative risk=1.9;95%CI:0.7-5),BO (relative risk=1.0;CI:0.5-2.0), or overall mortality (relative risk 1.0;95%CI:0.6-1.7). In our pediatric population the highest risk for CMV pneumonitis is associated with a CMV+ donor but CMV pneumonitis does not appear to be a risk factor for mayor complications or mortality. Thus, these data do not support matching CMV status between donor and recipient.