Epidemiology and Clinical Impact of Confirmed Respiratory Viral Infections in Solid Organ Transplant Recipients

TL;DR

This study examines how respiratory viral infections affect non-lung transplant patients, finding high hospitalization rates and identifying SARS-CoV-2 as a major risk for severe outcomes.

Contribution

The study provides new insights into the clinical impact and risk factors for respiratory viral infections in non-lung solid organ transplant recipients.

Findings

SARS-CoV-2 was the most common virus and associated with higher risk of complications.

Influenza infections were linked to lower risk of severe outcomes compared to other viruses.

Co-infections did not lead to worse outcomes than single infections.

Abstract

Respiratory viral infections (RVIs) can have distinct clinical presentations and outcomes in non‐lung solid organ transplant (SOT) recipients compared to non‐transplant and lung transplant patients. Understanding their impact is crucial for improving patient care and outcomes.

This multicenter retrospective study analyzed adult non‐lung SOT recipients with PCR‐confirmed symptomatic RVIs from eight Dutch hospitals (January 2013–July 2024) to characterize clinical characteristics and outcomes of mono‐ and co‐infections and identify risk factors for intensive care admission or 30‐day mortality.

In total, 603 RVIs were identified in 460 recipients (kidney: 501; liver: 75; pancreas/islet of Langerhans: 4; combined: 23). The most common viruses were SARS‐CoV‐2 (36%), influenza A/B (29%), rhinovirus (14%), and RSV (7%). Influenza cases showed higher rates of fever (72%), common cold symptoms (37%), and myalgia (29%) than other viruses. Hospitalization occurred in 68% (384/565). Factors independently associated with intensive care admission or 30‐day mortality included higher CURB‐65 score (OR 1.91; 95% CI 1.36–2.70; p < 0.01), radiologic infiltrates (OR 3.04; 95% CI 1.60–5.80; p < 0.01), and SARS‐CoV‐2 infection (OR 1.67; 95% CI 1.05–2.67; p = 0.03). In contrast, influenza infection was associated with a lower risk (OR 0.21; 95% CI 0.07–0.62; p < 0.01). Co‐infections were not linked to worse outcomes compared to mono‐infections.

Overall, RVIs in non‐lung SOT recipients were associated with high hospitalization and mortality rates. SARS‐CoV‐2 posed the highest risk for complications, while influenza was associated with a lower risk of severe outcomes. No association was found between co‐infection and poor outcomes.

Figures