TOPLINE

Among hospitalized lung transplant recipients with respiratory syncytial virus (RSV) infection, nearly 60% developed hypoxic respiratory failure, and more than 17% required mechanical ventilation. Baseline oxygen use and lower respiratory tract symptoms increased the risk for hypoxic respiratory failure, older age increased the risk for mechanical ventilation, and mechanical ventilation was strongly associated with mortality.

METHODOLOGY

• Researchers conducted a retrospective, multicenter cohort study of lung transplant recipients hospitalized with polymerase chain reaction-confirmed RSV infection between January 2016 and December 2019 across seven international transplant centers in the United States, Canada, and Australia.
• They included 155 recipients (median age at RSV diagnosis, 61 years), with RSV infection occurring a median of 14 months post-transplant; most patients were receiving prednisone (93.5%), tacrolimus (68.4%), and mycophenolate (68.4%) at the time of infection.
• The researchers assessed study outcomes including hypoxic respiratory failure on admission, mechanical ventilation, secondary bacterial or fungal infections in the lung, changes in forced expiratory volume in 1 second (FEV1), and 90-day all-cause mortality, as well as risk factors associated with these outcomes.
• All patients were followed up for 90 days after RSV diagnosis, except for FEV1 that was assessed up to 6 months after infection.

TAKEAWAY

• Hypoxic respiratory failure was observed in 58.7% of patients; baseline oxygen use was associated with nearly fivefold higher odds of hypoxic respiratory failure (odds ratio [OR], 4.81; P = .030), and lower respiratory tract symptoms were associated with nearly fourfold higher odds (OR, 3.74; P = .006).
• Mechanical ventilation was required for 17.4% of patients. Older age was associated with an increased risk for mechanical ventilation (OR, 1.06; P = .011), whereas oral ribavirin was associated with reduced odds (OR, 0.34; P = .016); however, this association was not significant when oral and inhaled ribavirin were combined (OR, 0.77; P = .68).
• Secondary bacterial or fungal infections occurred in 33.5% of patients, with mechanical ventilation being the only significant predictor (OR, 3.71; P = .003); Pseudomonas aeruginosa, Staphylococcus aureus, and non-Pseudomonas gram-negative organisms were the most common bacterial pathogens.
• Mechanical ventilation was independently associated with 90-day mortality (hazard ratio, 7.79; P < .001); overall 90-day mortality was 7.7%, occurring at a median of 21 days after RSV diagnosis. Median FEV1 fell from 2.01 to 1.69 L.

IN PRACTICE

"[O]utcomes of RSV infection in LT [lung transplant] recipients were suboptimal, especially in older recipients. This emphasizes the importance of further studies to improve outcomes in this vulnerable population through prevention and treatment modality such as vaccines and monoclonal antibodies," the authors of the study concluded.

SOURCE

The study was led by Maria Alejandra Mendoza, MD, Division of Infectious Diseases, University of Utah, Salt Lake City. It was published online on October 08, 2026, in Open Forum Infectious Diseases.

LIMITATIONS

The retrospective design raised the potential for information bias, and differences in hospitalization criteria and treatment protocols across centers may have caused bias or confounding. The association between oral ribavirin and reduced mechanical ventilation may reflect confounding by indication or immortal time bias. Data collection ended in December 2019, precluding assessment of RSV vaccination impact.

DISCLOSURES

The study received no specific funding. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.