Bridges N D, Spray T L, Collins M H, Bowles N E, Towbin J A
Division of Pediatric Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
J Thorac Cardiovasc Surg. 1998 Oct;116(4):617-23. doi: 10.1016/S0022-5223(98)70168-0.
Our goal was to examine the relationship between viral pneumonia and outcome in pediatric patients undergoing lung or heart-lung transplantation.
Prospective surveillance for common respiratory viruses of childhood was performed in all patients undergoing lung or heart-lung transplantation. Specimens were examined for the presence of replicating virus (by culture), viral genome (by polymerase chain reaction), and viral antigen (by immunofluorescence and immunohistochemical staining). The relationship between viral infection and outcome was examined.
Sixteen patients underwent 19 transplants during the study period, with follow-up of 1 to 26 months. Virus was identified in the transplanted lung in 29 instances; adenovirus was identified most commonly (8/16 patients) and had the greatest impact on outcome. In 2 patients with early, fulminant infection, adenovirus was also identified in the donor. Adenovirus was significantly associated with respiratory failure leading to death or graft loss and with the histologic diagnosis of obliterative bronchiolitis (P < or = .002 in each case).
Adenovirus infection in the transplanted lung is significantly associated with graft failure, histologic obliterative bronchiolitis, and death. Health care personnel and families must be vigilant in preventing exposure of transplant recipients to this virus. Availability of a rapid and reliable test for adenovirus in donors and recipients would have an impact on management and could improve outcome for pediatric lung recipients.
我们的目标是研究接受肺移植或心肺移植的儿科患者中病毒性肺炎与预后之间的关系。
对所有接受肺移植或心肺移植的患者进行儿童常见呼吸道病毒的前瞻性监测。检测标本中是否存在复制病毒（通过培养）、病毒基因组（通过聚合酶链反应）和病毒抗原（通过免疫荧光和免疫组织化学染色）。研究病毒感染与预后之间的关系。
在研究期间，16例患者接受了19次移植，随访时间为1至26个月。在移植肺中发现病毒29例；最常检测到的是腺病毒（16例患者中的8例），且对预后影响最大。在2例早期暴发性感染患者中，供体中也检测到腺病毒。腺病毒与导致死亡或移植物丢失的呼吸衰竭以及闭塞性细支气管炎的组织学诊断显著相关（每种情况P≤0.002）。
移植肺中的腺病毒感染与移植物衰竭、组织学闭塞性细支气管炎和死亡显著相关。医护人员和家属必须警惕防止移植受者接触这种病毒。供体和受者中腺病毒快速可靠检测方法的可用性将对管理产生影响，并可能改善儿科肺移植受者的预后。
