Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study

Article Article scientifique Article Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study eng 2014 author Bridevaux Pierre-Olivier 0000-0002-8021-0950 656483 author Aubert J.-D. author Gasche-Soccal Paola Marina Alessandra 33623 author Mazza-Stalder J. author Berutto C. author Rochat Thierry 28557 author Turin Lara 649669 author Van Belle Sandra 591140 author Nicod Philippe 638779 author Meylan Patrick 730695 author Wagner-killy Germaine 533711 author Kaiser Laurent 28229 32-38 10.1136/thoraxjnl-2013-203581 24025442 0040-6376 Background The incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was to characterise the incidence and outcomes of viral respiratory infections in LTR. Methods Patients were seen in three contexts: studyspecific screenings covering all seasons; routine posttransplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses. Results One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively (p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3). Conclusions There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection. Dewey 616 56 Département de médecine 221 false 400 Virologie clinique 668 311 Pneumologie Clinique 576 Thorax 69 1 a7fe80b6-640d-4973-a649-defbbcad3f91 Article (Published version) Public POBridevaux_Incidence and outcomes of respiratory viral infections lung transplant recipients.pdf 502311 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study	Thorax			2014	676	547

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Meylan, Patrick