Human Metapneumovirus, a Neglected Respiratory Viral Infection in Abdominal Transplant Recipients.

Abstract

Background: Human Metapneumovirus (hMPV) has been well recognized as a cause of respiratory illness in lung and bone marrow transplant recipients. However, little has been reported in the abdominal transplant population. The purpose of this study was to report the presentation, clinical course, and outcomes of hMPV infection in a series of kidney and pancreas transplant recipients. Methods: This was a retrospective study of hospitalized pts who were diagnosed with respiratory hMPV infection by polymerase chain reaction between January 2011 and June 2013. Results: During this period 11 pts with a positive BAL or nasopharyngeal aspirate were identified.Table: No Caption available.All pts presented with symptoms of respiratory infection. The most common symptoms were coughing, wheezing, dyspnea, and fever. Severity of symptoms ranged from shortness of breath with mild wheezing and no 02 requirement to hypoxemia requiring intubation. 6 pts required ICU level of care, 3 with co-infection at the time of hMPV detection, including 2 with CMV, and 1 with MRSA. Diagnosis of pneumonia (PNA) was confirmed radiographically in 9 pts. 3 pts received treatment for hMPV PNA, consisting of ribavirin and/or IVIg, as well as IS reduction in 2 pts. 3 untreated pts had IS reduced. 5 pts received supportive care only. A subset of 4 pts were diagnosed within 6 months of TX. 3 received basiliximab induction and 1 received alemtuzumab. 2 of these were co-infected at the time of hMPV detection. One pt was diagnosed with combined cellular and antibody-mediated rejection (AMR) and received rATG and PP/IVIg 5 months prior to hMPV detection. Another pt with chronic AMR had IS increased before hMPV detection. Of the 11 pts, 10 fully recovered with a median hospitalization of 7 days (range 2-56 days). One pt died of cardiogenic shock during hospitalization. 9 months after hMPV infection, one pt who had IS reduced developed AMR. Conclusions: Our experience demonstrates that in abdominal transplant recipients hMPV can result in significant morbidity and may contribute to pt death. We recommend screening for hMPV in such pts with acute respiratory illness requiring hospitalization. Optimal treatment of hMPV warrants further study.