Low incidence of severe respiratory syncytial virus infections in lung transplant recipients despite the absence of specific therapy.

Abstract

BACKGROUND:

Respiratory syncytial virus (RSV) infections in lung transplant recipients (LTRs) have been associated with significant morbidity and mortality. Immunoglobulins, ribavirin, and palivizumab are suggested treatments for both pre-emptive and therapeutic purposes. However, in the absence of randomized, placebo-controlled trials, efficacy is controversial and there is toxicity as well as cost concerns.

METHODS:

We retrospectively reviewed cases of lower respiratory tract RSV infections in adult LTRs. Diagnosis was based on clinical history, combined with a positive polymerase chain reaction (PCR) and/or viral cultures of bronchoalveolar lavage (BAL) specimens.

RESULTS:

Ten symptomatic patients were identified (7 men and 3 women, age range 28 to 64 years). All were hospitalized for community-acquired respiratory tract infections. Two patients had a concomitant acute Grade A3 graft rejection, and 1 patient had a concomitant bacterial pneumonia. Eight patients did not receive a specific anti-RSV treatment because of clinical stability and/or improvement at the time of RSV diagnosis. Only 2 patients (1 with Grade A3 allograft rejection and 1 requiring mechanical ventilation) received ribavirin and palivizumab. All patients recovered without complications and with no persistent RSV infection. However, bronchiolitis obliterans (BOS) staging worsened in 6 patients during the mean follow-up of 45 months.

CONCLUSIONS:

Our data suggest that mild RSV infections in LTRs might evolve favorably in the absence of specific anti-viral therapy. However, this observation needs confirmation in a large clinical trial specifically investigating the development of BOS in untreated vs treated patients.

• Authors: Ilker Uçkay, Paola M Gasche-Soccal, Laurent Kaiser, Richard Stern, Jesica Mazza-Stalder, John-David Aubert, Christian van Delden
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 29 Issue 3 Pg. 299-305 (Mar 2010) ISSN: 1557-3117 [Electronic] United States
• PMID: 19837611 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Bronchoalveolar Lavage Fluid (virology)
• Female
• Forced Expiratory Volume (physiology)
• Humans
• Incidence
• Lung (virology)
• Lung Diseases (surgery)
• Lung Transplantation
• Male
• Middle Aged
• Postoperative Complications (drug therapy, epidemiology, virology)
• Respiratory Syncytial Virus Infections (drug therapy, epidemiology, physiopathology)
• Respiratory Syncytial Viruses (isolation & purification)
• Retrospective Studies
• Severity of Illness Index