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Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study.
Thorax. 2014 Jan; 69(1):32-8.T

Abstract

BACKGROUND

The incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was to characterise the incidence and outcomes of viral respiratory infections in LTR.

METHODS

Patients were seen in three contexts: study-specific screenings covering all seasons; routine post-transplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses.

RESULTS

One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively (p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3).

CONCLUSIONS

There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection.

Authors+Show Affiliations

Division of Pulmonary Medicine, University Hospitals of Geneva, , Geneva, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24025442

Citation

Bridevaux, Pierre-Olivier, et al. "Incidence and Outcomes of Respiratory Viral Infections in Lung Transplant Recipients: a Prospective Study." Thorax, vol. 69, no. 1, 2014, pp. 32-8.
Bridevaux PO, Aubert JD, Soccal PM, et al. Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study. Thorax. 2014;69(1):32-8.
Bridevaux, P. O., Aubert, J. D., Soccal, P. M., Mazza-Stalder, J., Berutto, C., Rochat, T., Turin, L., Van Belle, S., Nicod, L., Meylan, P., Wagner, G., & Kaiser, L. (2014). Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study. Thorax, 69(1), 32-8. https://doi.org/10.1136/thoraxjnl-2013-203581
Bridevaux PO, et al. Incidence and Outcomes of Respiratory Viral Infections in Lung Transplant Recipients: a Prospective Study. Thorax. 2014;69(1):32-8. PubMed PMID: 24025442.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study. AU - Bridevaux,Pierre-Olivier, AU - Aubert,J-D, AU - Soccal,P M, AU - Mazza-Stalder,J, AU - Berutto,C, AU - Rochat,T, AU - Turin,L, AU - Van Belle,S, AU - Nicod,L, AU - Meylan,P, AU - Wagner,G, AU - Kaiser,Laurent, Y1 - 2013/09/11/ PY - 2013/9/13/entrez PY - 2013/9/13/pubmed PY - 2014/3/29/medline KW - Lung Transplantation KW - Respiratory Infection KW - Viral infection SP - 32 EP - 8 JF - Thorax JO - Thorax VL - 69 IS - 1 N2 - BACKGROUND: The incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was to characterise the incidence and outcomes of viral respiratory infections in LTR. METHODS: Patients were seen in three contexts: study-specific screenings covering all seasons; routine post-transplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses. RESULTS: One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively (p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3). CONCLUSIONS: There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection. SN - 1468-3296 UR - https://www.unboundmedicine.com/medline/citation/24025442/Incidence_and_outcomes_of_respiratory_viral_infections_in_lung_transplant_recipients:_a_prospective_study_ L2 - http://thorax.bmj.com/cgi/pmidlookup?view=long&amp;pmid=24025442 DB - PRIME DP - Unbound Medicine ER -