TY - JOUR
T1 - Community-acquired Respiratory Viruses Are a Risk Factor for Chronic Lung Allograft Dysfunction
AU - Peghin, Maddalena
AU - Los-Arcos, Ibai
AU - Hirsch, Hans H.
AU - Codina, Gemma
AU - Monforte, Víctor
AU - Bravo, Carles
AU - Berastegui, Cristina
AU - Jauregui, Alberto
AU - Romero, Laura
AU - Cabral, Evelyn
AU - Ferrer, Ricard
AU - Sacanell, Judith
AU - Román, Antonio
AU - Len, Oscar
AU - Gavaldà, Joan
PY - 2019/9/13
Y1 - 2019/9/13
N2 - © 2018 The Author(s). 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.
AB - © 2018 The Author(s). 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.
KW - bronchiolitis obliterans
KW - chronic rejection
KW - lung transplantation
KW - respiratory virus
KW - viral infection
U2 - 10.1093/cid/ciy1047
DO - 10.1093/cid/ciy1047
M3 - Article
C2 - 30561555
VL - 69
SP - 1192
EP - 1197
ER -
