Update in the treatment of non-influenza respiratory virus infection in solid organ transplant recipients

ABSTRACT

Introduction: Despite the improved outcomes in solid organ transplantation with regard to prevention of rejection and increased patient and graft survival, infection remains a common cause of morbidity and mortality. Respiratory viruses are a frequent and potentially serious cause of infection after solid organ transplantation. Furthermore, clinical manifestations of respiratory virus infection (RVI) may be more severe and unusual in solid organ transplant recipients (SOTRs) compared with the non-immunocompromised population.

Areas covered: This article reviews the non-influenza RVIs that are commonly encountered in SOTRs. Epidemiologic and clinical characteristics are highlighted and available treatment options are discussed.

Expert opinion: New diagnostic tools, particularly rapid molecular assays, have expanded the ability to identify specific RVI pathogens in SOTRs. This is not only useful from a treatment standpoint but also to guide infection control practices. More data are needed on RVIs in the solid organ transplant population, particularly regarding their effect on rejection and graft dysfunction. There is also a need for new antiviral agents active against these infections as well as markers that can identify which patients would most benefit from treatment.

KEYWORDS:

• Adenovirus
• coronavirus
• human metapneumovirus
• respiratory syncytial virus
• parainfluenza
• rhinovirus
• cidofovir
• brincidofovir
• ribavirin

Article highlights

• Respiratory viral infections are a significant complication among solid organ transplant recipients and lung transplant recipients are especially prone to complications from these infections.

• In solid organ transplant recipients with respiratory viral infection, bacterial and/or fungal coinfection is more common than in immunocompetent individuals.

• Solid organ transplant recipients with respiratory viral infection are more likely to shed virus for a longer duration compared to immunocompetent patients.

• Timing of respiratory viral infections in transplant recipients largely parallels infection in the community.

• All solid organ transplant recipients with suspected respiratory viral infection should have a nasopharyngeal sample tested by PCR.

• Adenovirus infection may be due to reactivation or new infection in immunocompromised patients.

• Currently, antiviral treatments are limited, but several new therapies are being studied for respiratory viral infections.

This box summarizes key points contained in the article.

Declaration of interest

N.M. Clark has received research funding from Chimerix and Ansun Biopharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.