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Meta-Analysis
. 2022 Jul 6;74(12):2252-2260.
doi: 10.1093/cid/ciab969.

Respiratory Syncytial Virus, Human Metapneumovirus, and Parainfluenza Virus Infections in Lung Transplant Recipients: A Systematic Review of Outcomes and Treatment Strategies

Auke de Zwart  1 , Annelies Riezebos-Brilman  2 , Gerton Lunter  3 , Judith Vonk  3 , Allan R Glanville  4 , Jens Gottlieb  5 , Nitipong Permpalung  6   7 , Huib Kerstjens  1 , Jan-Willem Alffenaar  8   9   10 , Erik Verschuuren  1
Affiliations
Meta-Analysis

Respiratory Syncytial Virus, Human Metapneumovirus, and Parainfluenza Virus Infections in Lung Transplant Recipients: A Systematic Review of Outcomes and Treatment Strategies

Auke de Zwart et al. Clin Infect Dis. .

Abstract

Background: Respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (hMPV) are increasingly associated with chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR). This systematic review primarily aimed to assess outcomes of RSV/PIV/hMPV infections in LTR and secondarily to assess evidence regarding the efficacy of ribavirin.

Methods: Relevant databases were queried and study outcomes extracted using a standardized method and summarized.

Results: Nineteen retrospective and 12 prospective studies were included (total 1060 cases). Pooled 30-day mortality was low (0-3%), but CLAD progression 180-360 days postinfection was substantial (pooled incidences 19-24%) and probably associated with severe infection. Ribavirin trended toward effectiveness for CLAD prevention in exploratory meta-analysis (odds ratio [OR] 0.61, [0.27-1.18]), although results were highly variable between studies.

Conclusions: RSV/PIV/hMPV infection was followed by a high CLAD incidence. Treatment options, including ribavirin, are limited. There is an urgent need for high-quality studies to provide better treatment options for these infections.

Keywords: lung transplantation; paramyxovirus; pneumovirus; ribavirin.

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Figures

Figure 1.
Figure 1.
Prisma flow chart.
Figure 2.
Figure 2.
Forest plot of odds ratio for CLAD according to ribavirin treatment. Summary odds ratio is from the random effects generalized linear mixed effect model (τ2 = 0.24). Abbreviations: CI, confidence interval; CLAD, chronic lung allograft dysfunction; GLMM: generalized linear mixed effect model; OR: odds ratio; RBV, ribavirin.
See this image and copyright information in PMC

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