Original clinical science
Oral versus inhaled ribavirin therapy for respiratory syncytial virus infection after lung transplantation

https://doi.org/10.1016/j.healun.2012.04.002Get rights and content

Background

Respiratory syncytial virus (RSV) is a significant contributor to morbidity in adult lung transplant recipients. Multiple modes of ribavirin administration have been described in the literature. This study investigated outcomes related to delivery route.

Methods

We performed a retrospective analysis of adult lung transplant patients infected with RSV (2006–2010). RSV severity was graded according to clinical symptoms and bronchiolitis obliterans syndrome (BOS) status on International Society for Heart and Lung Transplantation (ISHLT) criteria. Relationships between route of ribavirin delivery and RSV severity, BOS progression at 6 months after RSV infection, and overall survival were assessed. Of 30 RSV-positive patients identified, 9 were ultimately excluded.

Results

The 21 study patients were a mean age of 49 ± 17 years (range, 17–72 years) at transplant. Six received oral and 15 received inhaled ribavirin per clinician preference. No significant differences were observed between the groups by age, sex, or ethnicity. Mean time from transplant to RSV was 26 ± 29 months (range, 1–100 months). Infections were mild in 2 of 6 patients in the oral compared with 11 of 15 in the inhaled group (p = 0.17). None of the oral group and 3 of the inhaled group exhibited BOS 1 at time of infection (p = 0.53); 2 (inhaled) had new onset/progression of BOS at 6 months after RSV (p > 0.99). No difference in overall survival (p = 0.41) was observed between the 2 groups.

Conclusions

This retrospective study demonstrates no significant differences in 6-month outcomes between oral and inhaled ribavirin therapy for RSV infection after lung transplantation.

Section snippets

Methods

The Cleveland Clinic Institutional Review Board approved this study.

Results

Initially, 30 RSV-positive patients were identified, but 4 were excluded due to absence of BOS data and 4 due to enrollment in an interventional RSV treatment study. One additional patient received both oral and inhaled ribavirin and was also excluded.

Discussion

RSV infection after lung transplantation is common (up to 21%) in adults, and the mortality rate of RSV infection in this population remains at 10% to 20%, despite advances in supportive therapy.7, 8 Moreover, RSV infection in lung transplant recipients has been associated with severe lower respiratory tract infections, BOS progression, and both poor short-term and long-term outcomes.1, 3, 20 Kumar et al20 detected biopsy-proved acute rejection or a decline in FEV1 ≥ 20% in 33.3% of lung

Disclosure statement

Dr Budev is the site investigator for an Alnylam RSV study at the Cleveland Clinic. None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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