Viral infections in lung transplantation

Abstract

Viral infections account for up to 30% of all infectious complications in lung transplant recipients, remaining a significant cause of morbidity and even mortality. Impact of viral infections is not only due to the direct effects of viral replication, but also to immunologically-mediated lung injury that may lead to acute rejection and chronic lung allograft dysfunction. This has particularly been seen in infections caused by herpesviruses and respiratory viruses. The implementation of universal preventive measures against cytomegalovirus (CMV) and influenza (by means of antiviral prophylaxis and vaccination, respectively) and administration of early antiviral treatment have reduced the burden of these diseases and potentially their role in affecting allograft outcomes. New antivirals against CMV for prophylaxis and for treatment of antiviralresistant CMV infection are currently being evaluated in transplant recipients, and may continue to improve the management of CMV in lung transplant recipients. However, new therapeutic and preventive strategies are highly needed for other viruses such as respiratory syncytial virus or parainfluenza virus, including new antivirals and vaccines. This is particularly important in the advent of the COVID-19 pandemic, for which several unanswered questions remain, in particular on the best antiviral and immunomodulatory regimen for decreasing mortality specifically in lung transplant recipients. In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.

COVID-19-Associated Lung Fibrosis: Two Pathways and Two Phenotypes, Lung Transplantation, and Antifibrotics

“…These patients typically had low absolute lymphocyte counts (<0.6 × 10 3 /dl) and elevated ferritin levels (>150 ng/mL) [7]. Generally, the association between respiratory viral infections and the development of CLAD is suggested to be stronger in the case of symptomatic viral infections [8][9][10][11]. In one study asymptomatic respiratory viral infections were not associated with a significant decline in lung function [11,12].…”

“…Generally, the association between respiratory viral infections and the development of CLAD is suggested to be stronger in the case of symptomatic viral infections [8][9][10][11]. In one study asymptomatic respiratory viral infections were not associated with a significant decline in lung function [11,12]. If this also holds true for SARS-CoV-2 infections currently is unknown.…”

Risk factors of wound infection after lung transplantation: a narrative review

“…Risk factors of wound infection after lung transplantation: a narrative review die in the first year after surgery (2), which may be closely related to transplant failure, acute rejection, infection, and other complications.…”

Medical Complications of Lung Transplantation

“…The long-term survival rates of LTRs remain poor because of CLAD and infections [ 7 ], as about 35% of LTRs still die within 1 year after LT [ 8 ]. Preventive antimicrobial prophylaxis is very important to reduce the incidence of bacterial, viral, and fungal infections after LT [ 7 - 11 ].…”

“…When CMV resistance is detected, IV foscarnet or cidofovir may be used [ 34 ]. The implementation of universal preventive antiviral prophylaxis against CMV, vaccination for influenza, and early antiviral treatment have reduced viral infections and improved the survival and quality of life in LTRs [ 11 ].…”