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Respiratory syncytial virus infections in pediatric liver transplant recipients
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
Respiratory syncytial virus (RSV) infections in pediatric liver transplant patients present similarly to those in healthy children. Early post-transplant RSV diagnosis and prior lung issues may indicate a higher risk of severe illness.
Area of Science:
- Pediatric Infectious Diseases
- Transplant Hepatology
- Pediatric Pulmonology
Background:
- Respiratory syncytial virus (RSV) is a primary cause of lower respiratory tract infections in young children.
- Liver transplantation in children carries risks, including opportunistic infections.
- Understanding RSV impact in immunocompromised pediatric populations is crucial.
Purpose of the Study:
- To investigate the clinical presentation and outcomes of RSV infection in children following liver transplantation.
- To identify risk factors associated with severe RSV disease in this specific patient group.
Main Methods:
- Retrospective chart review of 17 pediatric liver transplant recipients diagnosed with RSV.
- Analysis of patient demographics, timing of infection, clinical symptoms, radiographic findings, and outcomes.
- Comparison of RSV clinical spectrum in transplant recipients versus the general pediatric population.
Main Results:
- RSV was diagnosed in 17 of 493 pediatric liver transplant recipients (median age 20 months, median 24 days post-transplant).
- Thirteen patients acquired nosocomial RSV infections during recovery.
- Common symptoms included tachypnea, cough, fever, and congestion, with radiographic changes in 12 patients.
- Two deaths occurred due to progressive pulmonary disease in patients with early-onset infection (<20 days post-transplant) who required intubation.
Conclusions:
- RSV in pediatric liver transplant recipients exhibits a clinical spectrum comparable to that in healthy children.
- Early-onset RSV infection (within 20 days post-transplant) and pre-existing lung disease are potential predictors of more severe outcomes.
- Close monitoring and prompt management are essential for RSV-infected pediatric liver transplant patients.
Abstract:
Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection in infants and young children. The charts of 17 children found to have RSV among 493 children who underwent liver transplantation between February 1985 and February 1991 were reviewed. The median age at diagnosis was 20 months. Median time of diagnosis was 24 days after transplantation. Thirteen patients developed nosocomial infections while convalescing from their transplant. Common symptoms included tachypnea, cough, fever, and congestion. Acute radiographic changes were seen in 12 patients. Two deaths were associated with progressive pulmonary disease and occurred in children with infection early in the postoperative period who were intubated before the onset of symptoms. RSV in children after liver transplantation has a clinical spectrum similar to that in normal children. Early onset of infection (less than 20 days) after transplantation and preexisting lung disease may predict more severe disease.