1600. An Optimal Respiratory Syncytial Virus (RSV) Treatment in Lung Transplant Recipients: Oral Ribavirin, Inhaled Ribavirin, or Conservative Approach
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Background:

Respiratory syncytial virus (RSV) is a common community acquired infection in lung transplant recipients (LTRs). The mortality in RSV-infected LTRs has been reported as 10-20% despite antiviral therapy; however, there is no consensus regarding treatment given limited data.

Methods:

A retrospective study of all LTRs at Duke University during Jan 2013-May 2017 with a positive RSV PCR respiratory specimen was performed. Baseline characteristics, sites of infection, antiviral therapy, side effects, outcomes including all-cause 1-year mortality post RSV infection, and 90-day readmission rates were analyzed. The Cox proportional hazard model was used to adjust the effect of ribavirin (RBV) on mortality.

Results:

One hundred fourteen RSV infected LTRs were identified: 70 received oral RBV, 32 inhaled RBV and 12 supportive care only. Baseline characteristics were similar between the 3 groups except site of infection and oxygen requirement at diagnosis (see Table). Of 32 patients treated with inhaled RBV, 19 had a creatinine clearance <40 ml/min and 8 were unable to take oral drugs. Unadjusted all-cause 1-year mortality was highest in the supportive care group [33.3% vs 7.1% (oral RBV) vs 25% (inhaled RBV), p=0.01]. There were no significant differences in readmission rates among the 3 groups. The adjusted hazard ratio (HR) for death and oral RBV use was 0.27 ([0.07,1.1], p=0.07). The adjusted HR for death and inhaled RBV use was 0.90 ([0.22, 3.68], p=0.88). RBV was stopped prematurely in only 1 patient in the oral group due to nausea and vomiting.

Conclusion:

Oral and inhaled RBV appear to be well tolerated in LTRs. Our data supports the use of oral RBV as a safe alternative to inhaled RBV in LTRs. Additional studies are required to determine if LTRs with asymptomatic RSV infection would benefit from RBV therapy.

Supportive Care

N=12 (%)

Oral RBV

N=70 (%)

Inhaled RBV

N=32 (%)

p-value

Site of infection

Upper respiratory tract

Lower respiratory tract

Asymptomatic

1 (8.3)

3 (25)

8 (66.7)

32 (45.7)

24 (34.3)

14 (20)

11 (34.4)

18 (56.3)

3 (9.4)

0.0004

Oxygen requirement at diagnosis

None

1-2 L/min

>2 L/min

8 (66.7)

2 (16.7)

2 (16.7)

61 (87.1)

6 (8.6)

3 (4.3)

18 (56.3)

4 (12.5)

10 (31.3)

0.003

Nitipong Permpalung, MD, MPH1, Tany Thaniyavarn, MD2, Jennifer Saullo, MD, PharmD1, Sana Arif, MBBS1, Rachel Miller, MD1, John Reynolds, MD2 and Barbara D. Alexander, MD, MHS, FIDSA1, (1)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (2)Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC

Disclosures:

N. Permpalung, None

T. Thaniyavarn, None

J. Saullo, None

S. Arif, None

R. Miller, scynexis: Investigator , Research support .

J. Reynolds, None

B. D. Alexander, None

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