title: Oral versus inhaled ribavirin therapy for respiratory syncytial virus infection after lung transplantation.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is a significant contributor to morbidity in adult lung transplant recipients. Multiple modes of ribavirin administration have been described in the literature. This study investigated outcomes related to delivery route.
  
  
  METHODS
  We performed a retrospective analysis of adult lung transplant patients infected with RSV (2006-2010). RSV severity was graded according to clinical symptoms and bronchiolitis obliterans syndrome (BOS) status on International Society for Heart and Lung Transplantation (ISHLT) criteria. Relationships between route of ribavirin delivery and RSV severity, BOS progression at 6 months after RSV infection, and overall survival were assessed. Of 30 RSV-positive patients identified, 9 were ultimately excluded.
  
  
  RESULTS
  The 21 study patients were a mean age of 49 ± 17 years (range, 17-72 years) at transplant. Six received oral and 15 received inhaled ribavirin per clinician preference. No significant differences were observed between the groups by age, sex, or ethnicity. Mean time from transplant to RSV was 26 ± 29 months (range, 1-100 months). Infections were mild in 2 of 6 patients in the oral compared with 11 of 15 in the inhaled group (p = 0.17). None of the oral group and 3 of the inhaled group exhibited BOS 1 at time of infection (p = 0.53); 2 (inhaled) had new onset/progression of BOS at 6 months after RSV (p > 0.99). No difference in overall survival (p = 0.41) was observed between the 2 groups.
  
  
  CONCLUSIONS
  This retrospective study demonstrates no significant differences in 6-month outcomes between oral and inhaled ribavirin therapy for RSV infection after lung transplantation.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA.
authors.forename: Lily
authors.initials: L
authors.lastname: Li
authors.forename: Robin
authors.initials: R
authors.lastname: Avery
authors.forename: Marie
authors.initials: M
authors.lastname: Budev
authors.forename: Sherif
authors.initials: S
authors.lastname: Mossad
authors.forename: Lara
authors.initials: L
authors.lastname: Danziger-Isakov
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage* / Q000627:therapeutic use*; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin