RSV IN lung transplant recipients was associated with respiratory failure, declining lung function, and mortality in hospitalized patients.
An international multicenter study of 155 adult lung transplant recipients hospitalized with respiratory syncytial virus (RSV) infection identified clinical predictors of severe complications, highlighting the importance of early assessment and continued monitoring in this vulnerable population.
Researchers retrospectively analyzed patients hospitalized with laboratory-confirmed RSV between 2016 and 2019 across seven transplant centers in the USA, Canada, and Australia. The median patient age was 61 years, and infection occurred a median of 14 months after transplantation.
Hypoxic respiratory failure developed in 58.7% of patients, while 17.4% required mechanical ventilation. All-cause mortality within 90 days reached 7.7%.
Patients requiring supplemental oxygen before infection had substantially greater odds of hypoxic respiratory failure (odds ratio [OR]: 4.81). Lower respiratory tract symptoms, including cough, chest pain, and shortness of breath, were also associated with increased odds (OR: 3.74).
Older age was associated with greater odds of requiring mechanical ventilation (OR: 1.06 per year), identifying an important factor when assessing hospitalized patients.
Oral ribavirin treatment was associated with lower odds of mechanical ventilation (OR: 0.34). However, this association was not significant when oral and inhaled formulations were analyzed together. Oral ribavirin was also not associated with improved 90-day survival.
These observational findings cannot establish treatment efficacy, particularly because prescribing decisions may have reflected differences in initial illness severity.
Secondary bacterial or fungal infections developed in 33.5% of patients within 90 days. Mechanical ventilation was associated with greater odds of secondary infection (OR: 3.71).
Among 61 patients with paired pulmonary function measurements, median forced expiratory volume in one second (FEV1) declined from 2.01 L before infection to 1.69 L afterward. Nearly half experienced reductions exceeding 10%.
Graft rejection was observed in 12.3% of recipients following RSV infection.
Mechanical ventilation was strongly associated with 90-day mortality (hazard ratio: 7.79), emphasizing the severity of respiratory deterioration in this population.
The retrospective design, limited number of deaths, and exclusive inclusion of hospitalized patients restrict generalizability. Outcomes also predate the availability of RSV vaccines.
The findings support careful respiratory monitoring, recognition of secondary infections, and further investigation of preventive strategies to protect lung transplant recipients.
Reference
Mendoza MA et al. Risk factors for hypoxia, mechanical ventilation, and mortality in lung transplant recipients hospitalized with respiratory syncytial virus: A multicenter international cohort study. Open Forum Infect Dis. 2026;doi:10.1093/ofid/ofag623.
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