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Human Metapneumovirus in Lung Transplant Recipients and Comparison to Respiratory Syncytial Virus

¹ Queensland Heart-Lung Transplant Unit, The Prince Charles Hospital, Brisbane, Australia; ² Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital, Brisbane, Australia; and ³ Clinical Medical Virology Centre, University of Queensland, Brisbane, Australia

Correspondence and requests for reprints should be addressed to Dr. Peter Hopkins, M.D., Department of Respiratory Medicine, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia 4032. E-mail: peterwakatipu{at}hotmail.com

Rationale: Human metapneumovirus is a newly described virus isolated in 2001 from children with acute respiratory viral infection. It has subsequently been reported globally, although there are limited data in lung transplant recipients.

Objectives: To prospectively analyze whether human metapneumovirus was circulating in our adult lung transplant community and assess the morbidity of this infection and to compare the clinical presentation and outcome after intravenous ribavirin of human metapneumovirus with that of respiratory syncytial virus (RSV).

Methods: Lung transplant patients with clinical features of respiratory viral infection underwent nasopharyngeal aspirates. Patients with a positive specimen for RSV or human metapneumovirus by reverse transcriptase–polymerase chain reaction analysis and graft dysfunction received intravenous ribavirin and pulse steroid therapy.

Measurements and Main Results: Eighty-nine patients had 199 visits for aspirate studies. A viral cause was determined for 62 visits in 47 patients (19 human metapneumovirus, 18 RSV, 13 parainfluenza, 9 influenza A, 2 adenovirus, and 1 influenza B). A significant percentage of patients with metapneumovirus (63%) and RSV (72%) developed graft dysfunction, with average declines in FEV₁ of 30 ± 12.4% and 25.9 ± 11.2%, respectively. In these patients, bronchiolitis obliterans syndrome onset or progression occurred in no patients with human metapneumovirus compared with 5 of 13 (38%) patients with RSV at 6 months.

Conclusions: Human metapneumovirus is a leading cause of acute respiratory tract illness in lung transplant recipients. The incidence and clinical spectrum at presentation are similar to RSV, although the latter seems to be associated with a higher risk of chronic rejection. We recommend testing of nasopharyngeal aspirates for human metapneumovirus with polymerase chain reaction to assess local epidemiologic patterns.

Key Words: respiratory • virus • solid organ transplant

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Acute respiratory viral infection in lung transplant recipients often has no cause identified on standard viral polymerase chain reaction tests, suggesting the presence of unidentified pathogens. Human metapneumovirus is a recently described paramyxovirus capable of infecting the respiratory tract, although few data exist on the epidemiology and response to therapy in such high-risk cohorts. What This Study Adds to the Field Human metapneumovirus among lung transplant recipients detection in lung transplant recipients and their response to ribavirin therapy. This virus was as frequent in occurrence as respiratory syncytial virus from nasopharyngeal aspirates but was not associated with a higher risk of chronic rejection.