1599. Rejection Outcomes in Lung Transplant Recipients Post Respiratory Syncytial Virus Infections
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Background:

Respiratory syncytial virus (RSV) infections in lung transplant recipients (LTRs) have been associated with bronchiolitis obliterans syndrome (BOS). However, limited data exists regarding the association of RSV with other types of rejection.

Methods:

This retrospective study of all RSV-infected LTRs at Duke University from Jan 2013-May 2017 examined acute cellular rejection (ACR), acute antibody mediated rejection (AMR), new human leukocyte antigen (HLA) detection, new donor specific antigen (DSA) detection, new BOS development and BOS progression at 1 year after RSV infection. Early and late RSV was defined as infection occurring ≤or >180 days post lung transplant, respectively. Logistic regression was performed to adjust risk of rejection.

Results:

Of 114 RSV-infected LTRs, 20 and 94 had early and late infection respectively. The cohort differs regarding underlying prior BOS, site of infection and RBV treatment (see table). Overall 1-year ACR after RSV infection was 44.7% (75% vs 38.3% in early and late groups, respectively). Patients with early RSV infection had significantly higher rate of new HLA and DSA detection (see table). After adjusting by infection site and RBV exposure, the odd ratios (OR) for new HLA detection for patients with early RSV was 5.4 [1.4, 20.7]. Both oral and inhaled RBV did not decrease the OR for ACR after adjusting for infection and timing of RSV infection after lung transplantation.

Conclusion:

Our data showed RSV infection was associated with very high rates of ACR in both early and later RSV groups. Patients with early RSV had higher rates of new HLA and DSA detection.

Early RSV

N=20 (%)

Late RSV

N=94 (%)

p-value

Underlying BOS prior to RSV infection

0

24 (25.5)

0.01

Site of infection

Upper tract

Lower tract

Asymptomatic

3 (15)

9 (45)

8 (40)

41 (43.6)

36 (38.3)

17 (18.1)

0.03

Treatment

Oral RBV

Inhaled RBV

Supportive care

4 (20)

10 (50)

6 (30)

66 (70.2)

22 (23.4)

6 (6.4)

<0.001

Concomitant IVIG

3 (15)

18 (19.4)

0.65

Rejections

ACR

Median episodes of ACR within 1 year after RSV infection (range)

AMR

15 (75)

1 (1-5)

3 (15)

36 (38.3)

1 (1-3)

4 (4.3)

0.03

0.38

0.07

New detection of:

HLA

DSA

BOS

7 (35)

6/7 (85.7)

4/20 (20)

10 (10.6)

3/10 (30)

19/70(27.1)

0.005

0.03

0.52

BOS progression (patients with prior BOS)

-

9/24 (37.5)

-

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, MHS1, (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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