Community-acquired respiratory viral infections were associated with increased acute rejection or FEV1 decline compared to uninfected lung transplant recipients (33.3% vs 6.7%; P=0.001).
Cohort (n=93)
Does community-acquired respiratory viral infection increase the risk of acute rejection and bronchiolitis obliterans syndrome in lung transplant recipients?
Community-acquired respiratory viral infections, whether symptomatic or asymptomatic, are significantly associated with acute rejection and obliterative bronchiolitis in lung transplant recipients.
Absolute Event Rate: 33.3% vs 6.7%
p-value: p=0.001
BACKGROUND: Community-acquired respiratory viral infections (RVIs) are common in lung transplant patients and may be associated with acute rejection and bronchiolitis obliterans syndrome (BOS). The use of sensitive molecular methods that can simultaneously detect a large panel of respiratory viruses may help better define their effects. METHODS: Lung transplant recipients undergoing serial surveillance and diagnostic bronchoalveolar lavages (BALs) during a period of 3 years were enrolled. BAL samples underwent multiplex testing for a panel of 19 respiratory viral types/subtypes using the Luminex xTAG respiratory virus panel assay. RESULTS: Demographics, symptoms, and forced expiratory volume in 1 sec were prospectively collected for 93 lung transplant recipients enrolled. Mean number of BAL samples was 6.2+/-3.1 per patient. A respiratory virus was isolated in 48 of 93 (51.6%) patients on at least one BAL sample. Of 81 positive samples, the viruses isolated included rhinovirus (n=46), parainfluenza 1 to 4 (n=17), coronavirus (n=11), influenza (n=4), metapneumovirus (n=4), and respiratory syncytial virus (n=2). Biopsy-proven acute rejection (> or =grade 2) or decline in forced expiratory volume in 1 sec > or =20% occurred in 16 of 48 (33.3%) patients within 3 months of RVI when compared with 3 of 45 (6.7%) RVI-negative patients within a comparable time frame (P=0.001). No significant difference was seen in incidence of acute rejection between symptomatic and asymptomatic patients. Biopsy-proven obliterative bronchiolitis or BOS was diagnosed in 10 of 16 (62.5%) patients within 1 year of infection. CONCLUSION: Community-acquired RVIs are frequently detected in BAL samples from lung transplant patients. In a significant percentage of patients, symptomatic or asymptomatic viral infection is a trigger for acute rejection and obliterative bronchiolitis/BOS.
Kumar et al. (2010) conducted a cohort in Lung transplant (n=93). Community-acquired respiratory viral infections vs. RVI-negative patients was evaluated on Biopsy-proven acute rejection (≥grade 2) or decline in forced expiratory volume in 1 sec ≥20% within 3 months (p=0.001). Community-acquired respiratory viral infections were associated with increased acute rejection or FEV1 decline compared to uninfected lung transplant recipients (33.3% vs 6.7%; P=0.001).