A. Purpose: Parainfluenza (PIV) is able to cause serious and even fatal infections after hematopoietic stem cell and lung transplantation. Limited data are available about the outcome and severity of PIV infections after kidney transplantation. We describe a recent outbreak of parainfluenza-3 infections in a kidney transplant unit.

B. Methods: Annually 200-240 kidney and 10-15 simultaneous pancreas-kidney (SPK) transplantation are performed in our institution. Baseline immunosuppression is cyclosporine or tacrolimus, mycophenolate and steroids. Induction with basiliximab is used in patients with higher immunological risk and with ATG in SPK patients. Due to renovations the kidney transplant unit was relocated in a ward not designed for immunosuppressed patients. Respiratory viral infections were diagnosed with a qualitative PCR recognizing several common respiratory viruses from naropharyngeal swab tests taken from symptomatic patients, and after the onset of outbreak from all exposed patients.

C. Results: During the outbreak altogether 45 patients were treated on the ward for early postoperative care after kidney or SPK transplantation. Respiratory viruses were tested from 30 patients (13 with upper or lower respiratory tract symptoms, 17 asymptomatic exposed patients). Parainfluenza-3 infection was confirmed in 12 patients, of which only one remained asymptomatic. In others, symptoms were mostly mild upper respiratory tract symptoms (rhinorrhea, nasal congestion, cough, fever, sore throat) and subsided within a few days. In two patients, lower respiratory tract symptoms were present (dyspnea, hypoxemia, pulmonary infiltrates in chest CT) and supplemental oxygen was required, but no ICU admission was needed. Of note, 4/6 of SPK patients were infected with PIV, compared to 8/39 of kidney transplant patients. In all patients who had follow-up nasopharyngeal swab tests taken, PIV-3 shedding was still detected 11-16 days after the first diagnosis. Despite rapid diagnosis and isolation of symptomatic patients, positive PIV-3 findings were diagnosed within a period of 24 days. The outbreak ceased only after closing down the transplant ward temporarily.

D. Conclusions: Parainfluenza-3 infections early after kidney or pancreas-kidney transplantation were mostly mild and no serious diseases occurred. PIV-3 easily infected immunosuppressed transplant recipients and prolonged viral shedding was detected.

CITATION INFORMATION: Helanterä I, Anttila V.-J, Lempinen M. Parainfluenza-3 Infections Early After Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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