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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.JH

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.

Authors+Show Affiliations

Service of Infectious Diseases, University of Geneva, Geneva, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19837611

Citation

Uçkay, Ilker, et al. "Low Incidence of Severe Respiratory Syncytial Virus Infections in Lung Transplant Recipients Despite the Absence of Specific Therapy." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 29, no. 3, 2010, pp. 299-305.
Uçkay I, Gasche-Soccal PM, Kaiser L, et al. Low incidence of severe respiratory syncytial virus infections in lung transplant recipients despite the absence of specific therapy. J Heart Lung Transplant. 2010;29(3):299-305.
Uçkay, I., Gasche-Soccal, P. M., Kaiser, L., Stern, R., Mazza-Stalder, J., Aubert, J. D., & van Delden, C. (2010). Low incidence of severe respiratory syncytial virus infections in lung transplant recipients despite the absence of specific therapy. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 29(3), 299-305. https://doi.org/10.1016/j.healun.2009.08.012
Uçkay I, et al. Low Incidence of Severe Respiratory Syncytial Virus Infections in Lung Transplant Recipients Despite the Absence of Specific Therapy. J Heart Lung Transplant. 2010;29(3):299-305. PubMed PMID: 19837611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low incidence of severe respiratory syncytial virus infections in lung transplant recipients despite the absence of specific therapy. AU - Uçkay,Ilker, AU - Gasche-Soccal,Paola M, AU - Kaiser,Laurent, AU - Stern,Richard, AU - Mazza-Stalder,Jesica, AU - Aubert,John-David, AU - van Delden,Christian, Y1 - 2009/10/17/ PY - 2009/02/09/received PY - 2009/08/04/revised PY - 2009/08/06/accepted PY - 2009/10/20/entrez PY - 2009/10/20/pubmed PY - 2010/7/7/medline SP - 299 EP - 305 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 29 IS - 3 N2 - 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. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/19837611/Low_incidence_of_severe_respiratory_syncytial_virus_infections_in_lung_transplant_recipients_despite_the_absence_of_specific_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(09)00639-1 DB - PRIME DP - Unbound Medicine ER -