Positive Pre-Transplant Respiratory Viral PCR is Associated With Increased Day 100 Transplant-Related Mortality in...

Hematopoietic stem cell transplant (HSCT) is a curative procedure for conditions requiring the replacement of bone marrow. Respiratory viral infections (RVI) in the lower respiratory tract (LRT) cause substantial morbidity and transplant-related mortality (TRM) in pediatric transplant recipients, but the impact of mild/asymptomatic RVI is unclear. Some studies have identified certain viral infections as high risk for posttransplant complications. To reduce transplant morbidity, a pretransplant RVI screening program was started at Children's National Hospital, which included symptom screening and respiratory viral (RV) PCR testing for each HSCT patient within 1 week of and on the day of HSCT admission. The objective of this study was to evaluate the impact of RVI on HSCT outcomes.

A retrospective review of pretransplant RV PCR, symptom screening, and clinical outcomes was performed for patients receiving allogeneic HSCT from July 1, 2016 to March 31, 2023. Exclusion criteria included missing pretransplant RV PCR and SCID to prevent bias.

A total of 161 patients were eligible to be included. Of the 161, 34 tested positive for RVs (26 low risk, eight high risk). Outcomes were initially analyzed separately by low- and high-risk viruses. Within the first 100 days posttransplant, a positive pre-HSCT RVI was significantly associated with increased TRM (odds ratio [OR] = 5.57, p = 0.04 after adjusting for multiple testing) and requirement for ICU transfer (OR = 3.45, p = 0.006).

Pretransplant RVI is associated with poor outcomes post-HSCT. Routine pretransplant viral testing may increase the safety of these transplants, but further work is needed to optimize strategies for mitigating the associated risks. Pretransplant viral testing allows providers to know when to monitor certain patients more closely posttransplant, and when to potentially delay elective transplant until the patient has cleared their virus.