Ribavirin efficacy in upper and lower respiratory tract paramyxovirus infection in lung transplant recipients

A.E.S. Zwart, A. Riezebos-Brilman, J.C. Alffenaar, W. van der Bij, M.E. Erasmus, E.A. Verschuuren

Friday 16 march 2018

10:50 - 11:00h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 15: Clinical

Aim

Paramyxovirus infections (PMVI) in lung transplant recipients (LTR) are associated with chronic lung allograft dysfunction (CLAD). The precise effect is still unclear, as is the role of upper and lower respiratory tract infection (URTI and LRTI). We retrospectively studied progression of CLAD after URTI and LRTI in a large cohort of PMVI in LTR.

Methods

All PMVI’s presented at our institution between 2009-2016 were included. FEV1 at presentation and 6 months post infection were analyzed and expressed as percentage of pre-infection FEV1. Patients were divided in URTI (FEV1 decrease < 10%) and LRTI (FEV1 decrease > 10%). Effect of ribavirin plus supportive care vs. supportive care only was then analyzed by comparing FEV1 postinfection between the groups. Patients presenting to the hospital within 14 days of symptom onset were included.

Results

In total 96 patients were included. 29 (30%) had an URTI (< 10% decrease in FEV1 at presentation) and 67 (70%) had a LRTI (> 10% decrease). Mean FEV1 at presentation in the URTI group was 94.7% (SD± 3.0%), in the LRTI it was 77.8% (SD± 15.0%). No significant differences in BOS grade pre-infection, type of transplant, virus type or gender were found between the URTI and LRTI groups in an univariate analysis. The mean FEV1 at 6 months post infection differed significantly between the groups: 100.5% (SD±9,3%) for the URTI group and 92.4% (SD±14.1%) for the LRTI group (p= 0.03). In patients with LRTI, FEV1 almost normalized with ribavirin six months post infection (97.8%) but was significantly worse in the untreated group (89.5%)(p= 0.02). In patients with URTI, FEV1 was unchanged 6 months after PMVI, irrespectively of ribavirin treatment.

Conclusion

Ribavirin treatment significantly improves FEV1 in LTR presenting with a LRTI defined as a FEV1 decline > 10% at presentation. Yet, LTR with a PMVI causing an URTI, defined as a FEV1 decline < 10% at presentation, recovered at 6 months regardless of ribavirin treatment. These results support the indication for ribavirin treatment of PMVI in LTR with LRTI.