Systemic Corticosteroids and Lung Function Recovery after Respiratory Viral Infection in Lung Transplant Recipients

Abstract

PurposeRespiratory viral infection (RVI) in lung transplant recipients (LTR) have variably been associated with poor outcomes. Our center uses systemic corticosteroids (orally or intravenous) in some RVI cases to treat inflammation based on clinical judgment, but evidence for this is limited.MethodsWe reviewed all adult LTR diagnosed with RVI (via nasopharyngeal swab or bronchoscopy) between 2017 and 2019. The primary outcome was recovery of lung function (forced expiratory volume in 1 second [FEV1]) at next stable visit between 1- and 12-months post-infection, expressed as a ratio between stable, representative FEV1 at follow up divided by stable FEV1 prior to infection (FEV1 recovery ratio). We modelled the association between steroid use and FEV1 recovery ratio using linear regression, adjusting for age, sex, transplant type, FEV1 presentation ratio (FEV1 at time of viral infection divided by stable FEV1 prior), hospitalization, coexistent bacterial or fungal infection, time post-transplant and CLAD status at infection.Results158 patients were diagnosed with RVI, 62 (39%) of whom received corticosteroids. 9 patients (6%) died prior to any follow-up lung function, including two deaths attributed to infection and two to bronchiolitis obliterans. Baseline characteristics were similar between steroid treated and untreated, but steroid-treated patients had a lower FEV1 presentation ratio (0.90 vs. 1.00, p=0.0094) and were more likely to have CLAD at infection (26% vs. 10%, p=0.0268). Mean FEV1 recovery ratio was 1.00 (SD 0.20) with no relationship to specific virus type. Steroid treatment was not associated with FEV1 recovery ratio either unadjusted (p=0.3709) or adjusted (p=0.4498).ConclusionTreatment with systemic corticosteroids was not associated with improved FEV1 recovery in our cohort even after adjustment for presentation severity and other factors. This suggests systemic steroids have limited utility in the management of RVI in this population. Respiratory viral infection (RVI) in lung transplant recipients (LTR) have variably been associated with poor outcomes. Our center uses systemic corticosteroids (orally or intravenous) in some RVI cases to treat inflammation based on clinical judgment, but evidence for this is limited. We reviewed all adult LTR diagnosed with RVI (via nasopharyngeal swab or bronchoscopy) between 2017 and 2019. The primary outcome was recovery of lung function (forced expiratory volume in 1 second [FEV1]) at next stable visit between 1- and 12-months post-infection, expressed as a ratio between stable, representative FEV1 at follow up divided by stable FEV1 prior to infection (FEV1 recovery ratio). We modelled the association between steroid use and FEV1 recovery ratio using linear regression, adjusting for age, sex, transplant type, FEV1 presentation ratio (FEV1 at time of viral infection divided by stable FEV1 prior), hospitalization, coexistent bacterial or fungal infection, time post-transplant and CLAD status at infection. 158 patients were diagnosed with RVI, 62 (39%) of whom received corticosteroids. 9 patients (6%) died prior to any follow-up lung function, including two deaths attributed to infection and two to bronchiolitis obliterans. Baseline characteristics were similar between steroid treated and untreated, but steroid-treated patients had a lower FEV1 presentation ratio (0.90 vs. 1.00, p=0.0094) and were more likely to have CLAD at infection (26% vs. 10%, p=0.0268). Mean FEV1 recovery ratio was 1.00 (SD 0.20) with no relationship to specific virus type. Steroid treatment was not associated with FEV1 recovery ratio either unadjusted (p=0.3709) or adjusted (p=0.4498). Treatment with systemic corticosteroids was not associated with improved FEV1 recovery in our cohort even after adjustment for presentation severity and other factors. This suggests systemic steroids have limited utility in the management of RVI in this population.