A single-season prospective study of respiratory viral infections in lung transplant recipients

Abstract

The frequency and complications of respiratory viral infections (RVI) were studied in 50 ambulatory lung transplant patients during a single winter season, using viral antigens, viral cultures and PCR of nasal washes or bronchoalveolar lavages. Patients' survival, episodes of acute rejection and occurrence of bronchiolitis obliterans (BO) or BO syndrome (BOS) were monitored for 1 yr after the study.Overall, 32 (64%) patients had 49 symptomatic episodes. Documented infections included eight due to respiratory syncytial virus (RSV), one due to parainfluenza virus (PIV) and 10 due to influenza (FLU). Four of the FLU infections were serological rises without symptoms. Overall, 17 (34%) patients had documented viral infection; four patients had lower respiratory involvement and two (one RSV, one PIV) were hospitalised for aerosolised ribavirin treatment.After 1 yr there were three (6%) deaths unrelated to RVI. BO or BOS had occurred in one (6%) out of 17 patients with and three (12%) out of 33 without RVI. Respiratory viruses infected onethird of ambulatory lung transplant recipients in a single season.In conclusion, respiratory viral infection was not associated with subsequent graft dysfunction. Larger prospective studies are required to better define the acute and long-term morbidity of these infections.

A 2010 working formulation for the standardization of definitions of infections in cardiothoracic transplant recipients

“…34 Some epidemiologic studies have suggested an association between respiratory viral infection and the development of bronchiolitis obliterans syndrome (BOS). [35][36][37][38][39][40] These studies yielded mixed results and the association between respiratory virus infection and BOS remains unclear. 41,42 The recent availability of molecular diagnostics, including PCR and multiplex gene techniques for the recovery of many viruses simultaneously from a single specimen, increased the recovery of pathogens in respiratory infections that previously were considered to be of undetermined etiology.…”

Oral versus inhaled ribavirin therapy for respiratory syncytial virus infection after lung transplantation

“…[1][2][3][4] RSV, a single-stranded, negativesense RNA virus, is a significant contributor to severe lower respiratory tract infections in lung transplant recipients. [5][6][7] Although the supportive care of patients with viral respiratory infections continues to improve, mortality rates of RSV infection in this population remain at 10% to 20%. 8 Early anti-viral therapy with ribavirin may be effective in RSV-infected patients not only after lung transplantation but also in other immunocompromised patient populations.…”

Respiratory Syncytial Virus in Hematopoietic Stem Cell Transplantation and Solid-Organ Transplantation

“…The cumulative incidence of RSV infection in lung transplant over 5-7 years has varied from 8 to 21 % in several retrospective series, with an annual incidence describe of 2-16 % [57][58][59][60][61][62][63][64]. Mortality attributable to LRD with RSV in this population has been reported from 10 to 20 % [57,60].…”