Human Metapneumovirus Infections in Lung Transplant Recipients: The Effects on Lung Allograft and Clinical Outcomes

Abstract

Human metapneumovirus infection (HMPVi) is a common community acquired infection in lung transplant recipients (LTRs), but data is very limited. This retrospective study of HMPVi in LTRs at the Johns Hopkins Hospital from Jan 2010 - April 2019 examined mortality, acute cellular rejection (ACR), donor specific antibody (DSA), chronic allograft dysfunction (CLAD) progression at 1 year after HMPVi as well as readmission, secondary bacterial/fungal infection at 90 days after HMPVi. The center's viral treatment practice included education for prompt diagnosis and consideration of ribavirin (RBV) usually with intravenous immunoglobulin (IVIG) for HMPVi. Of 31 HMPV infected LTRs, 22 received RBV (13 oral and 9 inhaled ribavirin) and 9 received supportive care only (SC). Baseline characteristics and infection parameters were similar among the 2 groups except concomitant respiratory bacterial pathogens at diagnosis, use of IVIG, and persistent HMPV shedding. In patients, whose respiratory viral PCR was repeated during day7-day30 post HMPVi, the SC group had significantly higher persistent viral shedding (66.7% vs 9.1% (RBV), p=0.03). There were no significant differences in readmission, death, CLAD progression, and DSA development among the 2 groups. The SC group had higher ACR rate (25% vs 0% (RBV), p = 0.03). Of 27 patients with complete pulmonary function tests, 11 (40.7%) developed CLAD progression within 1 year [50% (SC) vs 36.9% (RBV), p=0.53]. The SC group tended to have more fungal pathogen in respiratory samples (44.4% vs 13.6% (RBV), p= 0.06), but there were no significant differences in invasive fungal or bacterial infection at 90 days post HMPVs. Three patients reported side effects from RBV (nausea, diarrhea, and headache); none prematurely stopped RBV. RBV and IVIG may reduce risk of ACR and may help clear viral shedding. CLAD progression post HMPVi was 40% in this cohort and CLAD progression rates were not different among the 2 groups.