Role of CMV pneumonia in the development of obliterative bronchiolitis in heart-lung and double-lung transplant recipients

Abstract

Obliterative bronchiolitis (OB) is the main cause of late mortality after lung transplantation. Cytomegalovirus infection has been associated with late graft failure. The aim of this study was to determine whether the development of OB was related to CMV pretransplant serological status and to CMV infections. The study group comprised 36 lung transplant recipients (27 HLT and 9 DLT) who survived more than 4 months, of whom 47% developed OB (defined by the persistence of an unexplained obstructive disease: FEV1/VC < 0,7). OB occurred more frequently: (1) in seronegative recipients with seropositive donors (8/9) than in seropositive recipients (7/19) or seronegative well‐matched recipients (2/8); and (2) in patients who experienced CMV pneumonia (11/16) and CMV recurrence (11/16). Since matching seronegative recipients is the best way to prevent CMV infection, we believe that seronegative grafts must be reserved for seronegative recipients.

A Trial of Valganciclovir Prophylaxis for Cytomegalovirus Prevention in Lung Transplant Recipients

“…In addition to directly attributable effects, CMV may also have an immunomodulatory effect in transplant recipients, and active CMV disease has been found to be an independent risk factor for the development of other infectious complications such as bacteremia, invasive fungal disease and Epstein‐Barr virus related posttransplant lymphoproliferative disease (3–5). In addition, CMV may be an important risk factor for the development of bronchiolitis obliterans syndrome (BOS) postlung transplant (6,7). Given the potential for adverse consequences of CMV, strategies aimed at preventing the development of active infection are preferable.…”

Long‐term outcomes of cytomegalovirus infection and disease after lung or heart–lung transplantation with a delayed ganciclovir regimen

“…Human studies in lung transplantation have revealed mixed results in regards to the association of CMV and chronic graft dysfunction from BO/BOS. Some studies have reported a link between CMV lung infection and BOS (5, 23), while others were unable to document an association (2, 24–26). Heng et al.…”

Bronchiolitis Obliterans Syndrome: The Achilles' Heel of Lung Transplantation

“…The best evidence for this is in patients who develop cytomegalovirus (CMV) pneumoni-tis. 14,76,95,[156][157][158][159][160][161] CMV infection increases epithelial expression of donor HLA in transplant recipients 95 and upregulates proinflammatory cytokine expression. 162 The virus has also been found to share nucleic acid sequence homology with specific HLA antigens.…”