Clinical implications of respiratory virus infections in solid organ transplant recipients: a prospective study.
BACKGROUND
There is limited information about clinical consequences of respiratory virus infections (RVI) in solid organ transplant recipients. No prospective epidemiological study has been published previously.


METHODS
We selected a cohort of 152 transplant recipients (cardiac, hepatic and renal transplant recipients). Median time from transplantation was 17 months (range 1-50). They were prospectively followed-up for RVI during 7 months (October to April). Clinical and microbiological evaluation (cell culture, shell vial and polymerase chain reaction technique) of each RVI episode was made.


RESULTS
We detected 81 RVI (0.91 episodes/patient/year). Complications were detected in 15/81 episodes (18.5%): acute bronchitis (10 cases), pneumonia (three cases; 3.7% of RVI episodes) and bacterial sinusitis (2 cases). In 4 of 81 episodes (5%), patients needed hospitalization. A respiratory virus was isolated in 17 of 68 nasopharyngeal samples (six respiratory syncytial virus, six influenza, four picornavirus, one adenovirus). Fever presented an 83% positive predictive value for the diagnosis of influenza virus infection among those with a positive microbiological isolation. There were no episodes of acute rejection coincidentally with RVI. Only 54% of the subjects had been previously vaccinated against influenza.


CONCLUSIONS
Incidence of RVI among solid organ transplant recipients is similar to general population but complications are higher. A relationship between RVI and rejection was not detected. The rate of influenza vaccination was lower than expected. The presence of fever in a transplant recipient with RVI strongly suggests influenza infection.
López-Medrano
Francisco
F
Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain. flmedrano@yahoo.es
Aguado
Jose M
JM
Lizasoain
Manuel
M
Folgueira
Dolores
D
Juan
Rafael San
RS
Díaz-Pedroche
Carmen
C
Lumbreras
Carlos
C
Morales
Jose M
JM
Delgado
Juan F
JF
Moreno-González
Enrique
E
D000818:Animals; D002460:Cell Line; D045744:Cell Line, Tumor; D004285:Dogs; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000150:complications; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000150:complications*; D012307:Risk Factors; D012621:Seasons; D013997:Time Factors; D014777:Virus Diseases / Q000150:complications*