Evaluation of 10 years of parainfluenza virus, human metapneumovirus, and respiratory syncytial virus infections in lung transplant recipients

Auke E.S. de Zwart (Corresponding author), Annelies Riezebos-Brilman, Jan Willem C. Alffenaar, Edwin R. van den Heuvel, C. T. Gan, Wim van der Bij, Huib A.M. Kerstjens, Erik A.M. Verschuuren

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)

Abstract

Respiratory tract infection with pneumoviruses (PVs) and paramyxoviruses (PMVs) are increasingly associated with chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTRs). Ribavirin may be a treatment option but its effectiveness is unclear, especially with respect to infection severity. We retrospectively analyzed 10 years of PV/PMV infections in LTRs. The main end points were forced expiratory volume in 1 second (FEV 1 ) at 3 and 6 months postinfection, expressed as a percentage of pre-infection FEV 1 and incidence of new or progressed CLAD 6 months postinfection. A total of 139 infections were included: 88 severe infections (63%) (defined as >10% FEV 1 loss at infection) and 51 mild infections (37%) (≤10% FEV 1 loss). Overall postinfection CLAD incidence was 20%. Associations were estimated on postinfection FEV 1 for ribavirin vs no ribavirin (+13.2% [95% CI: 7.79; 18.67]) and severe vs mild infection (-11.1% [95% CI: -14.76; -7.37]). Factors associated with CLAD incidence at 6 months were ribavirin treatment (odds ratio (OR [95% CI]) 0.24 [0.10; 0.59]), severe infection (OR [95% CI] 4.63 [1.66; 12.88]), and mycophenolate mofetil use (OR [95% CI] 0.38 [0.14; 0.97]). These data provide valuable information about the outcomes of lung transplant recipients with these infections and suggests possible associations of ribavirin use and infection severity with long-term outcomes. Well-designed prospective trials are needed to confirm these findings.

Original languageEnglish
Pages (from-to)3529-3537
Number of pages9
JournalAmerican Journal of Transplantation
Volume20
Issue number12
Early online date2020
DOIs
Publication statusPublished - Dec 2020

Keywords

  • antibiotic
  • antiviral
  • clinical research
  • practice
  • infection and infectious agents - viral
  • infectious disease
  • lung (allograft) function
  • dysfunction
  • lung transplantation
  • pulmonology

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