Impact of Respiratory Syncytial Virus Infection on Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients

Purpose Respiratory syncytial virus infection (RSVI) in lung transplant recipients (LTRs) has been associated with bronchiolitis obliterans syndrome (BOS) development and progression, but data have been derived from small studies. Methods This is a retrospective study of RSVI in LTRs at Duke University from Jan 2013 - May 2017. Decrement in FEV1 was determined by comparison of the FEV1 at 90 days post-RSVI to pre-RSVI baseline. Results Of 114 LTRs with RSVI, 15 had preexisting BOS and 99 did not have preexisting BOS. Those with preexisting BOS had a longer duration from transplant surgery to RSVI, more concomitant respiratory bacterial pathogens and less acute cellular rejection (ACR) within 90 days preceding RSVI compared to those without. Within 1-year of RSVI, 7/15 (46.7%) patients with preexisting BOS had BOS progression and 25/99 (25.3%) patients developed new BOS. In patients with documented FEV1 measured pre- and post-RSVI, 6/12 (50%) with preexisting BOS and 23/90 (25.5%) without preexisting BOS had FEV1 decline ≥ 5%. Kaplan-Meier analysis showed patients with decline in FEV1 ≥ 5% at 90 days post-RSVI had a higher 1-year mortality (p=0.003). Conclusion Our experience supports an increase in BOS development post-RSVI. While BOS progression post-RSVI was common in patients with pre-existing BOS, rates of progression were not greater than those described for the natural history of BOS post-lung transplant. FEV1 decline ≥ 5% at 90 days post-RSVI was associated with higher mortality regardless of BOS status prior to RSVI.