Graft Loss and CLAD-Onset Is Hastened by Viral Pneumonia After Lung Transplantation

Abstract

Background Community acquired respiratory virus (CARV) infections occur frequently after lung transplantation and may adversely impact outcomes. We hypothesized that while asymptomatic carriage would not increase the risk of chronic lung allograft dysfunction (CLAD) and graft loss, severe infection would. Methods All lung transplant cases between January 2000 and July 2013 performed at our center were reviewed for respiratory viral samples. Each isolation of virus was classified according to clinical level of severity: asymptomatic, symptomatic without pneumonia, and viral pneumonia. Multivariate Cox modeling was employed to assess the impact of CARV isolation on progression to CLAD and graft loss. Results 4408 specimens were collected from 563 total patients with 139 patients producing 324 virus positive specimens in 245 episodes of CARV infection. Overall, the risk of CLAD was elevated by viral infection (HR 1.64, p < 0.01). This risk, however, was due to viral pneumonia alone (HR 3.94, p < 0.01), without significant impact from symptomatic viral infection (HR 0.97, p = 0.94) nor from asymptomatic viral infection (HR 0.99, p = 0.98). The risk of graft loss was not increased by asymptomatic CARV infection (HR 0.74, p = 0.37) nor symptomatic CARV infection (HR 1.39, p = 0.41). Viral pneumonia did, however, significantly increase the risk of graft loss (HR 2.78, p < 0.01). Conclusions With respect to CARV, only viral pneumonia increased the risk of both CLAD and graft loss after lung transplantation. In the absence of pneumonia, respiratory viruses had no impact on measured outcomes.

Infections after lung transplantation

“…A systemic review with pooled analysis involving 34 studies on CARV infections in lung transplant recipients failed to detect any association between viral infections and acute rejection (33). Data is as yet insufficient to accept or refute the association between CARV infections and the development of chronic rejection (34).…”

Heparin-binding protein, lysozyme, and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients

“…In addition, there are possible links between infection and the development of rejection . For example, viral pneumonia has been associated with chronic lung allograft dysfunction and graft loss . Moreover, growth of bacteria or fungi in bronchoalveolar lavage fluid (BALF) cultures does not always represent infection, as bacterial and fungal colonization of the transplanted lung is common.…”

DNA‐based testing in lung transplant recipients with suspected non‐viral lower respiratory tract infection: A prospective observational study

“…Atypical pathogens play an important role in immunocompromised patients and are often not covered by empirical anti‐microbial therapy, making targeted detection of these pathogens important. Furthermore, in the immunocompromised, viral infections can also lead to severe disease and can mimic bacterial infections with elevated blood inflammation markers …”

“…Furthermore, in the immunocompromised, viral infections can also lead to severe disease and can mimic bacterial infections with elevated blood inflammation markers. 3 LTx recipients with suspected LRTI require bronchoscopy with bronchoalveolar lavage (BAL) to detect offending pathogens. 4 Conventional microbiology testing by cultures is time consuming.…”