ABSTRACT
BACKGROUND: Paramyxovirus (PV) infections are increasingly recognized in lung transplant recipients and have been linked to subsequent graft failure and bronchiolitis obliterans syndrome (BOS). Ribavirin represents a possible treatment option although the outcome on graft function and BOS incidence is unknown. METHODS: We analysed outcomes of all PV infections in lung/heart-lung recipients between September 2006 and April 2009 in a single centre. PV-infected recipients treated with oral ribavirin were compared with those unable to receive ribavirin due to contraindications. Recovery of graft function, time to recovery and new development of BOS were compared. RESULTS: A total of 38 patients (ribavirin group) were treated with ribavirin for a median of 9 days (IQR 8-12), whilst 29 patients (non-ribavirin group) received best supportive care including corticosteroids. The median forced expiratory volume in 1 s dropped 20% (IQR 15-32) from baseline in the ribavirin group versus 18% (IQR 13-30) in the non-ribavirin group during infection. In 84% of patients treated with ribavirin and 59% of the non-ribavirin group, graft function recovered within 30 days (P=0.02). New onset of BOS developed within 6 months in 5% of the ribavirin group versus 24% of the non-ribavirin group (P=0.02). CONCLUSIONS: Treatment of PV after lung/heart-lung transplantation with oral ribavirin seems to be associated with earlier recovery of graft function and to prevent BOS.
Subject(s)
Antiviral Agents/therapeutic use , Lung Transplantation , Paramyxoviridae Infections/drug therapy , Respiratory Tract Infections/drug therapy , Ribavirin/therapeutic use , Adult , Ambulatory Care Facilities , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Bronchoalveolar Lavage Fluid/virology , Control Groups , Drug Therapy, Combination , Female , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Paramyxoviridae Infections/diagnosis , Prospective Studies , Respiratory System/pathology , Respiratory System/virology , Respiratory Tract Infections/diagnosis , Ribavirin/administration & dosage , Ribavirin/adverse effects , Schools, Medical , Spirometry , Time Factors , Treatment Failure , Treatment OutcomeABSTRACT
BACKGROUND: Patient-controlled home spirometry (HS) after lung transplantation has been shown to be valid and reliable to detect the presence of graft infection and rejection at its earliest onset. Effects of nonadherence to HS on detection of the bronchiolitis obliterans syndrome (BOS) and on graft survival are unknown. METHODS: A 7-year prospective cohort study assessed nonadherence longitudinally using electronic spirometry for 24 months. During follow-up, BOS, retransplantation, and survival were stratified by adherence groups. RESULTS: Electronic monitoring of 226 patients confirmed that 123,487 measures were performed. Period prevalence was 0.76 measures per patient day and decreased significantly over time (P<0.0001). During follow-up, BOS was developed in 32% of patients; 5% received a second transplant, and mortality rate was 19%. Kaplan-Meier event-free analysis showed decreased freedom from BOS time in nonadherers (30%) compared with good (43%) or moderate adherers (19%) (log rank 6.008; P<0.014) and a tendency toward lower retransplantation rates (log rank 3.14; P<0.07). Mantel Cox regression revealed no impact of adherence on patient survival. CONCLUSIONS: This was the first study assessing nonadherence to HS based on electronic monitoring in relation to long-term outcome after lung transplantation. Nonadherers showed decreased freedom from BOS in the largest sample to date, but did not impact survival.
