Parainfluenza and influenza virus infections in pediatric organ transplant recipients

We retrospectively reviewed parainfluenza and influenza virus infections that occurred in pediatric organ transplant recipients at our hospital from January 1985 through September of 1992. Cultures of respiratory specimens revealed 45 infections in 42 transplant recipients (32 cases of parainfluenza and 13 cases of influenza virus infection). The following organs were transplanted: liver (28 patients), small bowel with and without liver (4), heart (3), lung with and without heart (5), and kidney (2). Clinical presentations of the patients and outcomes were similar regardless of the type of virus isolated or the type of organ transplanted. There were 20 cases in which patients had upper respiratory symptoms but did not require supplemental oxygen, nine cases in which patients required oxygen supplementation only, and eight cases in which the patients survived with mechanical ventilation. Eight patients died (five had parainfluenza, three had influenza virus infection); four children had serious concurrent infections (cytomegaloviral pneumonia in one patient, bacteremia in two, bacteremia and pneumonia in one). Factors associated with poor outcome for the entire group were age (increased morbidity and mortality if < 6 months old), augmentation of immunosuppression, and onset of infection within 1 month of transplantation. In this patient population, parainfluenza and influenza infections were important causes of morbidity and mortality.