Table 2.
Outcomes associated with respiratory virus infections in lung transplant recipients
| Author (Ref) | Study period |
Population;
Number of patients; Study design |
Symptoms present with RV testing | Sample type | Laboratory testing method | RV detection (proportion positive) | Comments and outcomes associated with RVI |
|---|---|---|---|---|---|---|---|
| Gottlieb [40] | 2005-2007 | Adult N=388 Prospective |
Symptomatic and asymptomatic | NPS and BAL | IF, culture, PCR (PCR for 40% of pts) | 8% of patients | •BOS at 1 year: 27% RV-positive vs 9% RV-negative patients (P=0.01) •Predominance of paramyxoviridae (RSV, PIV, HMPV) •No patient with HRV or HCoV developed BOS |
| Hopkins [41] | 2003-2006 | Adult N=89 Prospective |
All symptomatic | NPS and BAL | IF, HMPV PCR | 9% of RTI | •Acute graft dysfunction: 63% of HMPV-infected vs 72% of RSV-infected patients •Chronic rejection in patients with acute graft dysfunction: 0% of HMPV-infected vs 38% of RSV-infected patients •No testing for HRV or HCoV |
| Kumar [42**] | 2003-2005 | Adult N=93 Prospective |
Symptomatic and asymptomatic | BAL only | Luminex, IF, culture | 52% of patients; 14% of samples | •Biopsy-proven acute rejection or significant decrease in FEV1: 33% of RV-positive vs 7% of RV-negative patients (P=0.001) •Predominance of HRV, HCoV, and PIV |
| Liu [43] | 1988-2005 | Pediatric N=576 Retrospective |
All symptomatic | NPS, BAL, sputum, tracheal aspirate | Culture, IF, PCR (mostly culture) | 14% of patients | •No association with acute or chronic rejection •RVI associated with decreased 1-year survival (HR 2.6) •Predominance of HRV, ADV, PIV, and RSV |
| Liu [44*] | 2002-2007 | Pediatric N=55 Retrospective |
All symptomatic | NPS, BAL, sputum, tracheal aspirate | Culture, IF, PCR (mostly culture) | 51% of patients | •No association with chronic rejection or mortality •Predominance of HRV, ADV, PIV |
| Milstone [45] | 1999-2000 | Adult N=50 Prospective |
All symptomatic | NPS, BAL | Culture, PCR, serology, antigen tests | 34% of patients | •No association with acute or chronic rejection •Predominance of RSV and influenza |
| Soccal [46*] | 2003-2006 | Adult N=77 Prospective |
Symptomatic and asymptomatic | NPS, BAL | PCR | 29% of NPS, 17% of BAL | • No association of RVI with biopsy-proven acute rejection • 66% of viruses in BAL were HRV or HCoV |
| Vilchez [47] | 1990-2000 | Adult N=454 Retrospective |
All symptomatic | BAL only | Culture | 5% of patients PIV-positive | • 82% of PIV-infected patients developed biopsy-proven acute rejection • 32% of PIV-infected patients developed chronic rejection |
| Weinberg [48*] | 2005-2007 | Adult N=60 Prospective |
All symptomatic | NPS, BAL | PCR, culture | 46% of RTI | • Clinically-diagnosed acute rejection: 45% of RV-positive vs 21% of RV-negative patients (P=0.002) • Chronic rejection: 25% of RV-positive vs 18% of RV-negative patients • Predominance of PIV, influenza, RSV |
NPS: nasopharyngeal specimen; BAL: bronchoalveolar lavage; IF: immunofluorescence, includes direct fluorescent antibody and enzyme immunoassay; RTI : respiratory tract infection based on symptoms; RVI : respiratory virus infection based on positive detection; FEV1 : forced expiratory volume in 1 second; BOS : bronchiolitis obliterans syndrome