Doan Minh L, Mallory George B, Kaplan Sheldon L, Dishop Megan K, Schecter Marc G, McKenzie E Dean, Heinle Jeffrey S, Elidemir Okan
Department of Pediatrics, Section of Pulmonology, Congenital Heart Surgery Service, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
J Heart Lung Transplant. 2007 Sep;26(9):883-9. doi: 10.1016/j.healun.2007.06.009.
Adenovirus pneumonia results in significant morbidity and mortality in lung transplant recipients. Cidofovir allows for directed therapy but can result in nephrotoxicity. We report our experience with cidofovir for the treatment of adenovirus pneumonia in pediatric lung transplant recipients.
In a retrospective review, we identified four cases of culture-proven adenovirus pneumonia in children who underwent lung transplantation at Texas Children's Hospital (TCH). All patients received cidofovir 1 mg/kg every other day or three times a week for a total of 4 weeks. Probenecid and intravenous hydration were administered in conjunction with the cidofovir. Intravenous immunoglobulin (IVIg) was given as adjunctive therapy, and immunosuppression was not modified during the treatment course.
The four cases of adenovirus pneumonia comprised 4 of the 54 (7%) lung transplantations performed at TCH from 2002 to 2006, and all were in children <3 years of age. All patients developed pneumonia within 2 months after transplantation. With cidofovir treatment, three of the four children survived. Among the survivors, two developed early bronchiolitis obliterans within 1 year after transplant, and one has continued to have good graft function at 2 years after transplant. All patients maintained normal renal function throughout the treatment course.
Pediatric lung transplant recipients <3 years of age are at increased risk of adenovirus pneumonia early after transplantation. Cidofovir, when used in the modified dosing regimen and in combination with IVIg and renal protection measures, is a safe and potentially effective treatment option for adenovirus pneumonia in lung transplant recipients.
腺病毒肺炎可导致肺移植受者出现显著的发病率和死亡率。西多福韦可用于针对性治疗，但可能导致肾毒性。我们报告了我们使用西多福韦治疗小儿肺移植受者腺病毒肺炎的经验。
在一项回顾性研究中，我们确定了德克萨斯儿童医院（TCH）接受肺移植的儿童中4例经培养证实的腺病毒肺炎病例。所有患者每隔一天或每周三次接受1mg/kg西多福韦治疗，共4周。丙磺舒和静脉补液与西多福韦联合使用。静脉注射免疫球蛋白（IVIg）作为辅助治疗，治疗过程中免疫抑制未改变。
2002年至2006年在TCH进行的54例肺移植中，4例腺病毒肺炎病例占4例（7%），且均为3岁以下儿童。所有患者在移植后2个月内发生肺炎。经西多福韦治疗，4名儿童中有3名存活。在幸存者中，2名在移植后1年内出现早期闭塞性细支气管炎，1名在移植后2年移植功能持续良好。所有患者在整个治疗过程中肾功能均保持正常。
3岁以下小儿肺移植受者在移植后早期发生腺病毒肺炎的风险增加。西多福韦采用改良给药方案，并与IVIg和肾脏保护措施联合使用时，是肺移植受者腺病毒肺炎的一种安全且可能有效的治疗选择。
