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Viral Respiratory Tract Infection During the First Postoperative Year Is a Risk Factor for Chronic Rejection After Lung Transplantation

Journal article
Authors Jesper Magnusson
Johan Westin
Lars-Magnus Andersson
Magnus Lindh
R. Brittain-Long
Rickard Nordén
Gerdt C. Riise
Published in Transplantation Direct
Volume 4
Issue 8
ISSN 2373-8731
Publication year 2018
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Biomedicine, Department of Infectious Medicine
Language en
Links dx.doi.org/10.1097/txd.000000000000...
https://journals.lww.com/transplant...
Keywords bronchiolitis obliterans syndrome, allograft dysfunction, working, formulation, human coronavirus, virus-infection, recipients, standardization, diagnosis, cohort, pcr, Transplantation
Subject categories Internal medicine

Abstract

Background. Chronic lung allograft dysfunction (CLAD) is the major limiting factor for long-term survival in lung transplant recipients. Viral respiratory tract infection (VRTI) has been previously associated with CLAD development. The main purpose of this study was to evaluate the long-term effects of VRTI during the first year after lung transplantation in relation to CLAD development. Method. Ninety-eight patients undergoing lung transplantation were prospectively enrolled between 2009 and 2012. They were monitored for infections with predefined intervals and on extra visits during the first year, the total follow-up period ranged between 5 and 8 years. Nasopharyngeal swab and bronchoalveolar lavage samples were analyzed using a multiplex polymerase chain reaction panel for respiratory pathogens. Data regarding clinical characteristics and infectious events were recorded. Results. Viral respiratory tract infection during the first year was identified as a risk factor for long-term CLAD development (P = 0.041, hazard ratio 1.94 [1.03-3.66]) in a time-dependent multivariate Cox regression analysis. We also found that coronavirus in particular was associated with increased risk for CLAD development. Other identified risk factors were acute rejection and cyclosporine treatment. Conclusions. This study suggests that VRTI during the first year after lung transplantation is associated with long-term CLAD development and that coronavirus infections in particular might be a risk factor.

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