Community-acquired Respiratory Viruses Are a Risk Factor for Chronic Lung Allograft Dysfunction

Maddalena Peghin, Ibai Los-Arcos, Hans H Hirsch, Gemma Codina, Víctor Monforte, Carles Bravo, Cristina Berastegui, Alberto Jauregui, Laura Romero, Evelyn Cabral, Ricard Ferrer, Judith Sacanell, Antonio Román, Oscar Len, Joan Gavaldà, Maddalena Peghin, Ibai Los-Arcos, Hans H Hirsch, Gemma Codina, Víctor Monforte, Carles Bravo, Cristina Berastegui, Alberto Jauregui, Laura Romero, Evelyn Cabral, Ricard Ferrer, Judith Sacanell, Antonio Román, Oscar Len, Joan Gavaldà

Abstract

Background: The relationship between community-acquired respiratory viruses (CARVs) and chronic lung allograft dysfunction (CLAD) in lung transplant recipients is still controversial.

Methods: We performed a prospective cohort study (2009-2014) in all consecutive adult patients (≥18 years) undergoing lung transplantation in the Hospital Universitari Vall d'Hebron (Barcelona, Spain). We systematically collected nasopharyngeal swabs from asymptomatic patients during seasonal changes, from patients with upper respiratory tract infectious disease, lower respiratory tract infectious disease (LRTID), or acute rejection. Nasopharyngeal swabs were analyzed by multiplex polymerase chain reaction. Primary outcome was to evaluate the potential association of CARVs and development of CLAD. Time-dependent Cox regression models were performed to identify the independent risk factors for CLAD.

Results: Overall, 98 patients (67 bilateral lung transplant recipients; 63.3% male; mean age, 49.9 years) were included. Mean postoperative follow-up was 3.4 years (interquartile range [IQR], 2.5-4.0 years). Thirty-eight lung transplant recipients (38.8%) developed CLAD, in a median time of 20.4 months (IQR, 12-30.4 months). In time-controlled multivariate analysis, CARV-LRTID (hazard ratio [HR], 3.00 [95% confidence interval {CI}, 1.52-5.91]; P = .002), acute rejection (HR, 2.97 [95% CI, 1.51-5.83]; P = .002), and cytomegalovirus pneumonitis (HR, 3.76 [95% CI, 1.23-11.49]; P = .02) were independent risk factors associated with developing CLAD.

Conclusions: Lung transplant recipients with CARVs in the lower respiratory tract are at increased risk to develop CLAD.

Keywords: bronchiolitis obliterans; chronic rejection; lung transplantation; respiratory virus; viral infection.

© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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