PURPOSE: Human parainfluenza virus 3 (HPIV-3) is known to cause severe respiratory compromise in lung transplant patients. Infection may lead to deterioration in lung function and development of bronchiolitis obliterans syndrome. This syndrome is characterized by persistent airflow obstruction, and is a major cause of allograft dysfunction. The purpose of this study is to quantify the degree of spirometric decline following treatment of HPIV-3 infection in lung transplant patients.
METHODS: This study is a retrospective review of all treated HPIV-3 upper respiratory infections in an adult lung transplant center over a 5 year period. The diagnosis of HPIV-3 was made through PCR analysis of bronchoalveolar lavage samples. Each patient was treated with a five day course of inhaled ribavirin. Routine pulmonary function tests were reviewed before and after infection. Data are expressed as averages with standard deviation.
RESULTS: The average age at time of infection was 58 years old. Six of the eleven patients had a double lung transplant (54%). The etiologies of primary lung disease were IPF (45%), COPD (37%), CF (9%) and hypersensitivity pneumonitis (9%). Infection occurred at an average of 14 months following transplant. Two patients had treated episodes of rejection, and one patient expired during the observation period. The average best FEV1 following lung transplant was 2.22L ± 0.74. The average FEV1 for all patients 1 month prior to infection was 1.68L ± 0.59. There was no significant decline in FEV1 noted in the 6 months preceding infection. The average decline from 1 month before infection to 6 months after infection was 0.30L ± 0.27. A statistically significant difference was found in the decline of FEV1 before and after infection (p=0.02).
CONCLUSION: Infection with HPIV-3 resulted in sustained graft dysfunction in adult lung transplant patients. A decline in spirometry after HPIV-3 infection is still evident at 3 to 6 months following treatment.
CLINICAL IMPLICATIONS: Future therapies targeted at primary prevention of HPIV-3 infection may avoid the significant harm brought about by this common viral infection.
DISCLOSURE: Jose Cantu, No Financial Disclosure Information; No Product/Research Disclosure Information