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

J Heart Lung Transplant. 2010 Mar;29(3):299-305. doi: 10.1016/j.healun.2009.08.012. Epub 2009 Oct 17.

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.

MeSH terms

  • 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
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / virology
  • Respiratory Syncytial Virus Infections / drug therapy
  • Respiratory Syncytial Virus Infections / epidemiology*
  • Respiratory Syncytial Virus Infections / physiopathology
  • Respiratory Syncytial Viruses / isolation & purification
  • Retrospective Studies
  • Severity of Illness Index*

Substances

  • Antiviral Agents