Community acquired respiratory viruses (CARVs) result in significant morbidity and mortality in lung transplant patients. Evidence for optimal treatment is limited and practices are variable among institutions. At our institution, many lung transplant patients with CARVs, specifically paramyxoviruses, are treated with inhaled ribavirin, resulting in significant cost. Oral ribavirin is used to treat these infections when FEV1 is < 35%. The objective of this study was to describe clinical outcomes and utilization of ribavirin therapy for treatment of CARVs.
Lung transplant recipients who received oral or inhaled ribavirin for the treatment of RSV, PIV, and hMPV between 2008 and 2014 were retrospectively reviewed. The primary outcome was return to baseline FEV1 at 30 days post-treatment. Secondary outcomes included mortality, progression of bronchiolitis obliterans syndrome (BOS) in the 6 months following treatment, initial reason for admission, and complications requiring extended hospital stay.
Eighty-two courses of inhaled ribavirin and 23 courses of oral ribavirin were evaluated. Baseline characteristics were similar among the two groups with the exception of FEV1 (mean % predicted: inhaled 72%, oral 46%) and BOS diagnosed prior to treatment (inhaled 26%, oral 61%). Return to baseline FEV1 by 30 days post-ribavirin occurred in 74% of the inhaled group and 75% of the oral group. BOS progression occurred in 6 patients (7%) in the inhaled group and 2 (9%) in the oral group. One death occurred during hospitalization in the oral ribavirin group, however this was determined not to be due to CARV infection. For utilization-related outcomes, 76 patients (93%) receiving inhaled ribavirin were admitted to the hospital solely for ribavirin administration and 4 patients (5%) developed additional complications resulting in extended hospital stays.
Use of inhaled or oral ribavirin for CARVs in lung transplant recipients was associated with favorable return to baseline FEV1 at 30 days and lack of BOS progression in the majority of patients. Other outcomes demonstrated significant resource utilization associated with inhaled ribavirin. Studies of relative efficacy of ribavirin products are lacking and warranted.
D. N. Fish, None
C. Derington, None
G. Barber, None
T. Goolsby, None
M. Zamora, None
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