The clinical impact of respiratory viruses on the lung function in lung transplant recipients and the role of Ribavirin in treatment.

Nawar, N. (Nouf) (2015) The clinical impact of respiratory viruses on the lung function in lung transplant recipients and the role of Ribavirin in treatment. thesis, Medicine.

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Abstract

Introduction: Lung transplant-recipients (LTx) are prone for complications upon viral respiratory infections (VRI) due to their immunosuppression. In these patients VRI, especially those with paramyxoviruses (PMV)* are associated with the development of Bronchiolitis Obliterans Syndrome. We analyzed the lung-function during and after PMV infections and compared it to that of other respiratory-viruses** to evaluate the impact of PMV. We have also analyzed the course of the lung function in a matched control group to study the effect of respiratory viruses on the lung function. In addition, the role of Ribavirin treatment of PMV infections was studied. Methods: Virological and spirometry data from 2008 until end January 2013 were extracted from our database. Patients were divided in two groups: patients with PCR proven VRI and a control group. The first group was further divided based on infection with PMV or other respiratory-viruses and Ribavirin treatment. In the VRI group, the lung-function was evaluated six months prior to infection, at clinical presentation and six months post infection. The course of the lung function of the VRI group was compared to that of the matched control group. Results: In total 266 patients were included in the study. Of these, 62 patients had a viral respiratory infection. Forty-three of these viral infections were PMV infections. In addition, 102 were selected as matched controls . Patients infected with respiratory viruses post transplantation show a decline of lung function of -7,9% at 6 months post infection compared to -4,9% of the control group (p=NS). Patients with VRIs occurring within two years post transplantation showed a decline of lung function of -10,5% at 6 months post infection compared to -4,7% of VRI occurring after two years post transplantation. (p=0.4 NS).PMV infected patients showed a decline of -13,7 % in lung-function at clinical presentation compared to -8,3% of those infected with other VRI’s (p=NS). Despite this difference at clinical presentation, the difference of the lung function at 6 months post infection was -7.2%, -9.5% respectively (p=NS). PMV infected patients treated with Ribavirin showed a decline of -18,6% in lung-function at clinical presentation compared to -10,1 % of those untreated (p=0.17). Despite this difference at clinical presentation, the difference of the lung function could no longer be observed at 6 months post infection (-7.9% vs. -7.4 respectively (p=NS)). Patients with PMV infections within the first 2 years post transplantation who are treated with Ribavirin showed a decline of -6% of lung function at 6 months post infection compared to -12 % of those untreated (p=0.6) Conclusions: Viral respiratory infections are common after lung-transplantation and almost double the decline in the lung function compared to a matched control. Of the viral respiratory infections, paramyxovirus infections have a trend to a larger decline in lung-function at clinical presentation compared to other respiratory viruses especially within 2 years after transplantation. Patients treated with Ribavirin recover similarly to those who aren't despite a significantly lower lung-function at presentation. A trend towards a positive effect of Ribavirin is seen when the infection occurs within 2 years post transplantation. The contribution of Ribavirin to the recovery in patients 2 years post transplantation is unclear. The relative good outcome despite the worse presentation suggests effectivity. A larger study is needed to demonstrate the effect of Ribavirin in PMV infection. *Human metapneumovirus (hMPV), respiratory syncitial virus(RSV), parainfluenza virus (PIV I-IV) **Influenza virus, coronavirus, rhinovirus, bocavirus and adenovirus

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Verschuuren E.A.M and Internist-clinical immunologist, Lung transplantation
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:05
Last Modified:	25 Jun 2020 11:05
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2522

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