Incidence, management and outcome of respiratory syncytial virus infection in adult lung transplant recipients: a nine-year retrospective multicenter study.

Abstract Objectives To analyze functional outcome parameters according to antimicrobial treatments after respiratory syncytial virus (RSV)-confirmed infection in adult lung transplant recipients. Methods A 9-year retrospective multicenter cohort study (2011-2019) included adult lung transplant recipients with RSV-confirmed infection. The first endpoint determined new allograft dysfunction (acute graft rejection, chronic lung allograft dysfunction [CLAD]) 3 months after infection. Then, baseline and 3-months post-infection forced expiratory volume in 1-second (FEV1) values were compared according to antimicrobial treatments. Univariate logistic regression analysis was used. Results RSV infection was confirmed in 77/424 lung transplant recipients (estimated incidence of 0.025 per patient/year, 95% [confidence interval] CI [0.018;0.036]). At 3 months, 22 (28.8%) recipients developed allograft dysfunction: 10 (13%) possible CLAD, 6 (7.9%) acute rejection and 6 (7.9%) CLAD. Recipients with the lowest pre-infection FEV1 had a greater risk of developing pneumonia (1.5 [IQR, 1.1-1.9] versus 2.2 [1.5-2.4] L/s; P=0.003) and a higher odds of receiving antibiotics (1.6 [IQR, 1.3-2.3] vs 2.3 [1.9-2.5] L/s; P=0.017; Odd ratio [OR] 0.52 95%CI [0.27;0.99]). In comparison with tracheobronchitis/bronchiolitis, VRS-induced pneumonia led more frequently to hospitalization (22 [91.7%] vs 29 [58.0%]; P=0.003) and ICU admission (8 [33.3%] vs 0 [0%]; P Conclusions At 3 months after RSV-confirmed infection, 22 (28.8%) recipients had new allograft dysfunction. Ribavirin treatment and azithromycin prophylaxis did not prevent FEV1 decline.