1. Christian Geltner, LKH Natters, Dept. of Pulmonology, Austria
PATTERNS OF RSV INFECTION IN ADULT LUNG TRANSPLANT RECIPIENTS C. Geltner1, B. Bucher1, A. Gschwendtner2, W. Tabarelli5, C. Larcher3, M. Freund 4, L. Müller5, H. Bonatti6 1 Department of Pulmonology, Landeskrankenhaus Natters; 2 Institute of Pathology, Coburg, Germany 3 Institute of microbiology and virology, General Hospital, Bolzano, Italy 4 Department of Radiology, University Hospital, Innsbruck 5 Department of Cardiac Surgery, University Hospital, Innsbruck 6 Department of General and Transplant Surgery, University of Innsbruck INNSBRUCK LUNG TRANSPLANTATION PROGRAM
STUDY
7/52 lung transplant recipients
All BAL +/- TBB positive for RSV
Epidemic 10/98 – 05/99
Retrospective analyses of symptoms, therapeutic outcome and survival
Purpose: RSV causes upper and lower respiratory tract infections in children. The most dangerous pattern is respiratory bronchiolitis and consecutive viral pneumonia. We observed multiple occurrences of RSV-infections in adult lung transplant recipients during an epidemic of RSV-bronchiolitis in children in the district of Tyrol, Austria. Patterns of disease, treatment and influence on late outcome after lung transplantation are analyzed
Rhinitis
Coughing
Fever
Lung function deterioration
Radiographic Infiltrates
SYMPTOMS
Histopathologic specimen: RSV in Transbronchial Biopsy, positive 3/7 patients
Results: All patients had symptoms of infection: cough (6/7) rhinitis (6/7) deterioration of lung function (6/7), fever (4/7) pulmonary infiltrates (2/7), respiratory failure (1/7). In 3/7 patients invasive viral pneumonia or bronchiolitis was found in transbronchial lung biopsies. 43% of the patients were suspected to have their symptoms due to the RSV-infection, 57% for bacterial superinfections.The patients were treated by antibiotics (86%), reduction of immunosuppression (100%), hospitalization (86%) and inhalative ribavirin therapy in 1 patient. All patients recovered. There was no late occurrence of bronchiolitis obliterans syndrome (BOS) 4 years after the RSV infection. The survival rate of these patients was 86% after 1 year, 72% at 2 years and 72% 4 years after infection.
Decrement of Immunosuppression (60%)
Antibiotics (85%)
Hospitalization (60%)
Ribavirin (15%)
THERAPY
Great variety of symptoms (none – severe pneumonia)
Often no specific treatment enough
RSV does not influence long term survival or occurence of BOS
Good prognosis per se
Often superinfections (bacteria/fungi)
Table 1: Symptoms of RSV-Infection
Data from study group
0 = YES/positive; 1 = NO/negative
OUTCOME
Methods: 7 out of 52 concecutive patients were detected with RSV infections of the lung allograft between October 1998 and May All patients had bronchoscopy with bronchiolo-alveolar lavage (BAL) and transbronchilal biopsies (TBB) for routine diagnostic purposes. The patients were years old and 11,5 months (range ) after transplant. The infection was detected by bronchoscopy and by a commercially available immunoassay.
Conclusion: RSV produces a wide range of symptoms in lung allograft recipient. Routine use of antiviral treatment is neither necessary nor recommended. All patients recovered without chronic deterioration of lung function. Later BOS was not detected in these patients. Survival after lung transplantation seems not to be influenced by RSV-infection.
Christian Geltner, LKH Natters, Dept. of Pulmonology, Austria