key: cord-0952618-srbqawsp
authors: Gärtner, Barbara C.; Avery, Robin K.
title: Respiratory viral infections in solid organ transplant recipients: New insights from multicenter data
date: 2020-12-20
journal: Am J Transplant
DOI: 10.1111/ajt.16408
sha: 39c9f0a83df6b8cc798e7d366deee7393aa5c384
doc_id: 952618
cord_uid: srbqawsp

Respiratory virus infections (RVI), a persistent source of morbidity and mortality for SOT recipients, have been best characterized in lung transplant recipients, in whom association with chronic lung allograft dysfunction has been reported1 . However, much less is known about clinical presentations and outcomes of RVI in non-lung-transplant SOT recipients.

The Swiss Transplant Cohort Study represents a remarkable accomplishment, involving detailed, prospective data collection on most solid organ transplants performed at Swiss transplant centers.

In the study by Mombelli et al, 696 RVIs were diagnosed in 3294 SOT recipients, with median follow-up of 3.4 years. 2 Cumulative incidence of RVIs was 60% in lung and 12% in nonlung recipients.

RVIs were asymptomatic in 13.3% of lung and 2.6% of nonlung SOT.

Hospitalization was required in 34.2%, and ICU admission in 3.9%; 30-day mortality was 0.18%. Bacterial coinfections occurred in 7.2% (and were associated with ICU admission) and fungal coinfections occurred in 3.4%. Use of oral ribavirin was uncommon in nonlung SOT recipients. Overall, RVIs were associated with graft loss or death in nonlung (but not lung) transplant recipients, but lower respiratory tract infections, and any occurrence of influenza, were associated with graft loss or death in both groups.

These interesting results raise many questions. First, the difference in asymptomatic infections between lung and nonlung recipients may reflect different testing thresholds, and detection of RVIs during surveillance bronchoscopies. Testing of an asymptomatic nonlung SOT recipient would be unlikely outside of a clinical trial; thus, the incidence of asymptomatic infection in the nonlung SOT group remains unclear. Another question relates to pathogenicity of different viruses. What interventions should these results lead us to implement? Treatment seems to be of limited effect (although use of oral ribavirin in nonlung recipients was uncommon). Thus, prevention may have a more prominent role. Since influenza was a major factor in morbidity and mortality, influenza vaccination will be key. Protection might by optimized by using a more potent vaccine (e.g., high-dose, 3 This study not only focused on viral infections, but also reported bacterial and fungal coinfections. The role of these different infectious agents is difficult to analyze, in terms of relative contributions to disease severity. Which is the main cause and which is the innocent bystander, or are both influencing disease?

Not surprisingly, bacterial infections were found to a high extent in patients in the ICU. Thus, managing coinfections might be of major importance.

A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients

Burden, epidemiology, and outcomes of microbiologically confirmed respiratory viral infections in solid organ transplant recipients: a nationwide, multi-season prospective cohort study

A double-blind, randomized trial of high-dose vs. standard-dose influenza vaccine in adult solid-organ transplant recipients

Decreased influenza activity during the COVID-19 pandemic -United States