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

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.