Methods: RSV was identified on nasopharyngeal and throat swabs (NPS) using indirect fluorescent antibody (IFA) in 17 symptomatic patients and confirmed by viral culture in 14/17. Patient age was 43 Ϯ 15(18 -63) years, m:f ϭ10:7, single: bilateral LTX ϭ 5:12, post-op 1444Ϯ1272(61-4598) days . Underlying diagnoses included cystic fibrosis (8), emphysema (7) and pulmonary fibrosis (2). All 17 received intravenous ribavirin (33 mg/kg on day 1 and 20 mg/kg/day thereafter in 3 divided doses) with oral prednisolone (1mg/kg) until repeat NPS were negative for RSV on IFA. Median therapy was 8(6 -14) days. Results: There was no mortality. No patient developed BOS. FEV 1 fell from 2.1Ϯ1.0L(0.7-3.7) to 1.8Ϯ0.9L(0.5-3.6) (pϽ0.001) but recovered to 2.1Ϯ 0.9(0.7-3.7) within 2 months and was maintained at a follow-up of 361Ϯ321(10 -838) days. Complications included mild hemolytic anemia (Hb fell from 124Ϯ21g/l(84 -154) to 107Ϯ18g/l(75-138): pϭ0.005). Cost savings were $US13,811/ case versus nebulised therapy at 6gm/d (pϽ0.001). Conclusions: This is the largest series of treated RSV cases after LTX and the first to show that IV ribavirin and oral corticosteroids is well tolerated and effective in reducing RSV related complications after LTX. Cost-utility is established versus nebulised therapy. Early diagnosis and management are integral to the efficacy of treatment to prevent severe airway epithelial injury and the sequelae of BOS.

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