Low incidence of severe respiratory syncytial virus infections in lung transplant recipients despite the absence of specific therapy.
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.
Uçkay
Ilker
I
Service of Infectious Diseases, University of Geneva, Geneva, Switzerland.
Gasche-Soccal
Paola M
PM
Kaiser
Laurent
L
Stern
Richard
R
Mazza-Stalder
Jesica
J
Aubert
John-David
JD
van Delden
Christian
C
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D015994:Incidence; D008168:Lung / Q000821:virology; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000998:Antiviral Agents