Respiratory Viruses and Solid Organ Transplant Recipients

Preemptive measures, preventative strategies, and interventions for RSV, Parainfluenza, Rhinovirus, Human MetaPneumovirus, Flu, Enterovirus, Adenovirus, and symptoms presenting at the time of organ offer.

  1. Preemptive measure for all listed patients:
    Weekly check-ins to the families to assess for symptoms, reminder for parents to call for any symptoms
  2. Preventive strategies for all listed patients and donor recipients
    Flu vaccine and palivizimab (see protocols)
  3. RSV and ParaInfluenza:
    • Recipient
      • If symptomatic and requiring hospitalization: Inhaled ribovarin before transplant and IVIg (400mg/kg) after transplant x1
      • If symptomatic and not hospitalized no interventions, if transplant becomes available and still symptomatic, IVIg and ribovarin if feasible:
      • if no symptoms at time of organ offer, no intervention
    • Donor positive, no interventions
  4. Rhinovirus and Human MetaPneumovirus:
    • Recipient: If symptomatic: before and after transplant IVIg (400mg/kg) x1
    • Donor positive: no interventions
  5. Flu:
    • Recipient: If symptomatic: oseltamivir (5 days can straddle transplant)
    • Donor positive: start oseltaminr in donor and finish a total of 5 day course in recipient
  6. Enterovirus:
    • Recipient: If symptomatic and requiring hospitalization: IVIg (400mg/kg) x1
    • Donor positive: rule out endocarditis for cardiac transplant only, if not present transplant, give IVIg (400mg/kg) x1
  7. Adenovirus:
    • If recipient or donor is positive: defer transplant
  8. Symptoms at time of organ offer:
    • If no time to test and identify the infecting organism and patient symptomatic, send respiratory PCR and give IVIg 400mg/kg
    • Symptoms include objective evidence of URI/LRI and no fever

The PDF version of this page can be found here:
Respiratory Viruses and SOT