University of Groningen, University Medical Center Groningen, Department of Pulmonary Medicine and Tuberculosis, Groningen, The Netherlands.
Laboratory for Medical Microbiology and Public Health, Hengelo, The Netherlands.
Clin Infect Dis. 2022 Jul 6;74(12):2252-2260. doi: 10.1093/cid/ciab969.
Respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (hMPV) are increasingly associated with chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR). This systematic review primarily aimed to assess outcomes of RSV/PIV/hMPV infections in LTR and secondarily to assess evidence regarding the efficacy of ribavirin.
Relevant databases were queried and study outcomes extracted using a standardized method and summarized.
Nineteen retrospective and 12 prospective studies were included (total 1060 cases). Pooled 30-day mortality was low (0-3%), but CLAD progression 180-360 days postinfection was substantial (pooled incidences 19-24%) and probably associated with severe infection. Ribavirin trended toward effectiveness for CLAD prevention in exploratory meta-analysis (odds ratio [OR] 0.61, [0.27-1.18]), although results were highly variable between studies.
RSV/PIV/hMPV infection was followed by a high CLAD incidence. Treatment options, including ribavirin, are limited. There is an urgent need for high-quality studies to provide better treatment options for these infections.
呼吸道合胞病毒（RSV）、副流感病毒（PIV）和人偏肺病毒（hMPV）与肺移植受者（LTR）的慢性肺移植物功能障碍（CLAD）的关系日益密切。本系统评价主要旨在评估 LTR 中 RSV/PIV/hMPV 感染的结局，其次评估利巴韦林疗效的证据。
检索相关数据库，并使用标准化方法提取研究结果并进行总结。
纳入了 19 项回顾性研究和 12 项前瞻性研究（共 1060 例病例）。30 天死亡率较低（0-3%），但感染后 180-360 天 CLAD 进展的比例较高（汇总发生率为 19-24%），可能与严重感染有关。探索性荟萃分析显示利巴韦林对 CLAD 的预防有一定效果（比值比 [OR] 0.61，[0.27-1.18]），尽管研究间结果差异较大。
RSV/PIV/hMPV 感染后 CLAD 的发生率较高。治疗选择有限，包括利巴韦林。迫切需要高质量的研究为这些感染提供更好的治疗选择。
