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

Auke E S de Zwart*, Annelies Riezebos-Brilman, Jan-Willem C Alffenaar, Edwin R van den Heuvel, C T Gan, Wim van der Bij, Huib A M Kerstjens, Erik A M Verschuuren

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)3529-3537
Number of pages9
JournalAmerican Journal of Transplantation
Issue number12
Early online date2020
Publication statusPublished - 17-Jun-2020


  • antibiotic
  • antiviral
  • clinical research
  • practice
  • infection and infectious agents - viral
  • infectious disease
  • lung (allograft) function
  • dysfunction
  • lung transplantation
  • pulmonology
  • RISK

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