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

Uçkay, Ilker; Gasche-Soccal, Paola M.; Kaiser, Laurent; Stern, Richard; Mazza-Stalder, Jesica; Aubert, John-David; van Delden, Christian

doi:10.1016/j.healun.2009.08.012

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 29, Issue 3 , Pages 299-305, March 2010

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

Presented in part as a poster at the meeting of Swiss Society of Infectious Diseases and Immunocompromised Host Society, Crans-Montana, Switzerland, July 2006.

Ilker Uçkay, MD
- Service of Infectious Diseases, University of Geneva, Geneva, Switzerland
Paola M. Gasche-Soccal, MD
- Service of Pulmonary Medicine, University of Geneva, Geneva, Switzerland
- Clinic of Thoracic Surgery, University of Geneva, Geneva, Switzerland
Laurent Kaiser, MD
- Service of Infectious Diseases, University of Geneva, Geneva, Switzerland
Richard Stern, MD
- Orthopaedic Surgery Service, University of Geneva, Geneva, Switzerland
Jesica Mazza-Stalder, MD
- Service of Pulmonary Medicine, University of Geneva, Geneva, Switzerland
- Service of Pulmonary Medicine, University Hospital of Vaud, Lausanne, Switzerland
John-David Aubert, MD
- Service of Pulmonary Medicine, University Hospital of Vaud, Lausanne, Switzerland
Christian van Delden, MD
- Service of Infectious Diseases, University of Geneva, Geneva, Switzerland
- Service of Transplantation, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Reprint requests: Christian van Delden, MD, Service of Transplantation, Department of Surgery, Hôpitaux Universitaire de Genève, 24 Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland. Telephone: ++41-22-372-32-07. Fax: ++41-22-372-98-30

published online 19 October 2009.

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.

Keywords: RSV, virus, infection, lung transplantation