RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Abstract

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of RNA respiratory viral infections in the pre‐ and post‐transplant period. Viruses reviewed include influenza, respiratory syncytial virus (RSV), parainfluenza, rhinovirus, human metapneumovirus (hMPV), and coronavirus. Diagnosis is by nucleic acid testing due to improved sensitivity, specificity, broad range of detection of viral pathogens, automatization, and turnaround time. Respiratory viral infections may be associated with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. The cornerstone of influenza prevention is annual vaccination and in some cases antiviral prophylaxis. Treatment with neuraminidase inhibitors and other antivirals is reviewed. Prevention of RSV is limited to prophylaxis with palivizumab in select children. Therapy of RSV upper or lower tract disease is controversial but may include oral or aerosolized ribavirin in some populations. There are no approved vaccines or licensed antivirals for parainfluenza, rhinovirus, hMPV, and coronavirus. Potential management strategies for these viruses are given. Future studies should include prospective trials using contemporary molecular diagnostics to understand the true epidemiology, clinical spectrum, and long‐term consequences of respiratory viruses as well as to define preventative and therapeutic measures.

SARS Cov-2 infection in a renal-transplanted patient: A case report

“…Given to the extent of the SARS-CoV-2 pandemic, solid organ transplant recipients are at risk to contract the disease. Nonetheless, disease course and prognosis in this group are unknown at the moment.Although viral pneumonia in solid organ transplant patients may present with mild or atypical symptoms at onset, complications occur more frequently than in immunocompetent hosts 3. A previous study described the clinical characteristics of two kidney-transplant recipients affected by MERS-CoV infection and reported a variable outcome -death in one case and complete resolution in the other case 4.…”

Community-Acquired Respiratory Viruses in Transplant Patients: Diversity, Impact, Unmet Clinical Needs

“…NAI therapy is associated with reduced mortality, reduced progression to pneumonia, reduced duration of shedding, and, among lung transplant recipients, reduced risk of development of chronic lung allograft dysfunction (60,96). Early therapy, defined as initiation in less than 24 to 48 h after symptom onset, is associated with the best outcomes in uncomplicated influenza infection of healthy nonimmunosuppressed patients as well as transplant patients (29,97,98). Nonetheless, therapy appears to be beneficial in this population beyond 48 h, most likely due to the higher and more prolonged viral replication load (Fig.…”

“…Nonetheless, therapy appears to be beneficial in this population beyond 48 h, most likely due to the higher and more prolonged viral replication load (Fig. 2), and all symptomatic transplant patients should be treated (28,29,97,98). Given the atypical and mild degree of symptoms, IV-A/B should remain in the differential diagnosis for any patient with fever or any respiratory or systemic symptoms consistent with influenza.…”

Pediatric heart transplant from an incompletely treated influenza A‐positive donor

“…8 Multiple adult centers have reported positive outcomes with transplants from influenza-positive donors, but uncertainty remains regarding the duration of donor and recipient antiviral therapy necessary to prevent disease transmission. 9 We recently published the first case report of a pediatric patient receiving a heart transplant from a donor with symptomatic influenza B disease. The donor had received a full course of oseltamivir…”

“…There has been uncertainty in cases in which donors are positive for influenza as to need for and duration of therapy of both the donor and recipient. 9 In 2010, the American Society for Transplantation, The Transplantation Society, and Canadian Society of Transplantation endorsed recommendations that influenza-positive donors be considered for non-lymphoid solid organ transplant, and, while acknowledging inadequate supporting data, suggested a full course of antiviral therapy be used prior to organ procurement whenever possible. 11 It is also of note that the Center for Disease Control maintains updated information in regard to specific antiviral resistances reported, which may play a role in antiviral therapy choice.…”