RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Clin Transplant. 2019 Sep;33(9):e13511 doi: 10.1111/ctr.13511.
Abstract

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of RNA respiratory viral infections in the pre- and post-transplant period. Viruses reviewed include influenza, respiratory syncytial virus (RSV), parainfluenza, rhinovirus, human metapneumovirus (hMPV), and coronavirus. Diagnosis is by nucleic acid testing due to improved sensitivity, specificity, broad range of detection of viral pathogens, automatization, and turnaround time. Respiratory viral infections may be associated with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. The cornerstone of influenza prevention is annual vaccination and in some cases antiviral prophylaxis. Treatment with neuraminidase inhibitors and other antivirals is reviewed. Prevention of RSV is limited to prophylaxis with palivizumab in select children. Therapy of RSV upper or lower tract disease is controversial but may include oral or aerosolized ribavirin in some populations. There are no approved vaccines or licensed antivirals for parainfluenza, rhinovirus, hMPV, and coronavirus. Potential management strategies for these viruses are given. Future studies should include prospective trials using contemporary molecular diagnostics to understand the true epidemiology, clinical spectrum, and long-term consequences of respiratory viruses as well as to define preventative and therapeutic measures.

Metadata
Organisation: Manuel, Oriol. Infectious Diseases Service and Transplantation Center, University Hospital and University of Lausanne, BH10-549, 1011, Lausanne, Switzerland. Estabrook, Michele. Division of Pediatric Infectious Diseases, Washington University School of Medicine in St. Louis.
Funding: Industry funding
Publication type: Guideline
Organ: Various; Kidney; Liver; Heart; Lung; Pancreas; Intestine; Simultaneous Kidney/Pancreas; Heart/Lung
Language: English
MeSH terms: Anti-Infective Agents; Humans; Organ Transplantation; Practice Guidelines as Topic; RNA Viruses; Respiratory Tract Infections; Societies, Medical; Transplant Recipients; Orthohantavirus; 0 (Anti-Infective Agents); Heart Transplantation; Kidney Transplantation; Liver Transplantation; Heart-Lung Transplantation; Lung Transplantation; Pancreas Transplantation