Single-centre experience with oral ribavirin in lung transplant recipients with paramyxovirus infections
Single-centre experience with oral ribavirin in lung transplant recipients with paramyxovirus infections
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DOI：
10.3851/imp1811
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发表时间：
2011-01-01
影响因子：
1.2
通讯作者：
Gottlieb, Jens
中科院分区：
文献类型：
--
作者：
Fuehner, Thomas;Dierich, Martin;Gottlieb, Jens
背景：副粘病毒（PV）感染越来越多地在肺移植受者中被认识到，并与随后的移植失败和闭塞性细支气管炎综合征（BOS）有关。利巴韦林代表了一种可能的治疗选择，尽管移植物功能和BOS发生率的结果尚不清楚。方法：我们分析了2006年9月至2009年4月在单个中心内所有肺/心肺受体PV感染的结果。将口服利巴韦林治疗的pv感染患者与由于禁忌症而无法接受利巴韦林治疗的患者进行比较。比较移植功能的恢复情况、恢复时间和BOS的新进展。结果：共有38例患者（利巴韦林组）接受了利巴韦林治疗，中位时间为9天（IQR 8-12），而29例患者（非利巴韦林组）接受了包括皮质类固醇在内的最佳支持治疗。感染期间，利巴韦林组1 s内的中位用力呼气量较基线下降20% (IQR 15-32)，而非利巴韦林组为18% （IQR 13-30）。在接受利巴韦林治疗的患者中，84%的患者和59%的非利巴韦林患者在30天内恢复了移植物功能（P=0.02）。利巴韦林组6个月内出现BOS新发的比例为5%，而非利巴韦林组为24% （P=0.02）。结论：口服利巴韦林治疗肺/心肺移植后PV似乎与移植功能的早期恢复和预防BOS有关。
Background: Paramyxovirus (PV) infections are increasingly recognized in lung transplant recipients and have been linked to subsequent graft failure and bronchiolitis obliterans syndrome (BOS). Ribavirin represents a possible treatment option although the outcome on graft function and BOS incidence is unknown.Methods: We analysed outcomes of all PV infections in lung/heart-lung recipients between September 2006 and April 2009 in a single centre. PV-infected recipients treated with oral ribavirin were compared with those unable to receive ribavirin due to contraindications. Recovery of graft function, time to recovery and new development of BOS were compared.Results: A total of 38 patients (ribavirin group) were treated with ribavirin for a median of 9 days (IQR 8-12), whilst 29 patients (non-ribavirin group) received best supportive care including corticosteroids. The median forced expiratory volume in 1 s dropped 20% (IQR 15-32) from baseline in the ribavirin group versus 18% (IQR 13-30) in the non-ribavirin group during infection. In 84% of patients treated with ribavirin and 59% of the non-ribavirin group, graft function recovered within 30 days (P=0.02). New onset of BOS developed within 6 months in 5% of the ribavirin group versus 24% of the non-ribavirin group (P=0.02).Conclusions: Treatment of PV after lung/heart-lung transplantation with oral ribavirin seems to be associated with earlier recovery of graft function and to prevent BOS.