Background Pre-transplant respiratory virus (RV) infections have been associated with negative transplant outcomes in adult hematopoietic cell transplantation (HCT) recipients. In the era of HCT delay due to high-risk RVs, we examined the impact of pre-transplant RV detection on transplant outcomes in a pediatric HCT recipients. Methods This retrospective cohort study included myeloablative allogeneic HCT recipients from 2010 to 2019. All patients were screened for RV at least once within 90 days before HCT using RT-PCR, regardless of symptoms. Post-transplant outcomes included days alive and out of hospital (DAOH) and progression to lower respiratory tract infection (LRTI). Results Among 310 patients, 134 had a RV detected in the 90 days prior to HCT. In univariable analysis, transplant factors including younger age, total body irradiation, umbilical cord blood transplantation, lymphocyte count less than 100/mm3, and HCT comorbidity index score ≥3, and viral factors including symptomatic infection, human rhinovirus (HRV) as a virus type, and symptomatic pre-transplant upper respiratory tract infection (URTI) were associated with fewer DAOH. In multivariable analysis, transplant factors remained significant, but not viral factors. There was a higher incidence of progression to post-transplant LRTI with the same pre-transplant RV if the last positive PCR before HCT was ≤30 days compared to >30 days (p=0.007). Conclusion In the setting of recommending HCT delay for high-risk RVs, symptomatic URTI, including HRV infections, may lead to increased duration of hospitalization and early progression to LRTI when transplantation is performed within 30 days of the last positive PCR test.

中文翻译：

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移植前呼吸道病毒检测对造血细胞移植儿童移植后结局的影响

背景 移植前呼吸道病毒 (RV) 感染与成人造血细胞移植 (HCT) 受者的阴性移植结果相关。在由于高风险 RV 导致 HCT 延迟的时代，我们研究了移植前 RV 检测对儿科 HCT 受者移植结果的影响。方法 这项回顾性队列研究包括 2010 年至 2019 年清髓性同种异体 HCT 受者。所有患者在 HCT 前 90 天内至少使用 RT-PCR 筛查一次 RV，无论症状如何。移植后结果包括存活天数和出院天数（DAOH）以及进展为下呼吸道感染（LRTI）。结果 在 310 名患者中，134 名患者在 HCT 前 90 天内检测到 RV。单变量分析中，移植因素包括年龄较小、全身照射、脐带血移植、淋巴细胞计数低于100/mm3、HCT合并症指数评分≥3，病毒因素包括有症状感染、人鼻病毒(HRV)作为病毒类型和有症状的移植前上呼吸道感染 (URTI) 与较少的 DAOH 相关。在多变量分析中，移植因素仍然很重要，但病毒因素则不然。与＞30天相比，如果HCT前最后一次阳性PCR≤30天，则在具有相同移植前RV的情况下进展至移植后LRTI的发生率更高(p＝0.007)。结论 在建议对高风险 RV 延迟 HCT 的情况下，当移植在最后一次 PCR 检测呈阳性后 30 天内进行时，有症状的 URTI（包括 HRV 感染）可能会导致住院时间增加和早期进展为 LRTI。