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

Respiratory tract infection with Pneumoviruses (PV) and Paramyxoviruses (PMV) are increasingly associated with chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR). Ribavirin may be a treatment option but its effectiveness is unclear, especially with respect to infection severity. We retrospectively analyzed ten years of PV/PMV infections in LTR. Main endpoints were FEV1 at three and six months post-infection, expressed as a percentage of pre-infection FEV1 and incidence of new or progressed CLAD six months post-infection. A total of 139 infections were included; 88 (63%) severe infections (defined as >10% FEV1 loss at infection), 51 (37%) mild infections (≤10% FEV1 loss). Overall post-infection CLAD incidence was 20%. Associations were estimated on post-infection FEV1 for ribavirin vs. no ribavirin (+13.2% [7.79;18.67]) and severe vs. mild infection (-11.1% [-14.76; -7.37). Factors associated with CLAD incidence at six months were ribavirin treatment (OR 0.24 [0.10-0.59]), severe infection (OR 4.63 [1.66;12.88]) and mycophenolate mofetil use (OR 0.38 [0.14;0.97]). This data provides 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.