Cytomegalovirus antibody status of donor/recipient does not influence the incidence of bronchiolitis obliterans syndrome in lung transplantation.
BACKGROUND
We have previously reported that prophylaxis for cytomegalovirus (CMV) infection does not influence the incidence of bronchiolitis obliterans syndrome (BOS) at 2 years. The effect of CMV infection (without evidence of disease) on BOS is still not well understood. Moreover, the incidence and risk factors for development of BOS in CMV-antibody-negative donor/recipient matches in lung transplantation have not been described. The aim of this study is to determine the incidence of BOS in lung transplant patients with CMV-antibody-negative (-) donors (D) and recipients (R), and to evaluate the risk factors that predispose to BOS in this sub-group.


METHODS
A retrospective study of data from the transplant database of our center was performed. All single-lung (SL), double-lung (DL) and heart-lung block (HL) transplant patients who survived >2 years post-transplant were included in the study group. They were grouped as follows: D(-)/R(-), n = 102; D(-)/R(+), n = 70; D(+)/R(-), n = 33, and D(+)/R(+), n = 92.


RESULTS
The 3-year BOS-free survival rates were 65%, 56%, 58% and 67%, respectively, and the incidence rates of BOS at 5 years post-transplant in the different groups were 57%, 62%, 78% and 55% (p > 0.05). In the D(-)/R(-) group, the significant risk factor for developing BOS was three or more episodes of acute rejection (p = 0.02). The mean numbers of acute rejection episodes per 100 patients-days within the first 6 months were 1.28, 1.06, 0.50 and 1.11 (p < 0.001 overall) for the four groups, respectively.


CONCLUSIONS
Although CMV is believed to be a risk factor for BOS, its absence did not affect the occurrence or incidence of BOS in lung transplant patients. The main risk factor for BOS in the CMV-antibody-negative population remains the number of acute rejection episodes within the first 6 months after transplantation.
Luckraz
Heyman
H
Transplant Unit, Papworth Hospital, Cambridge, UK. heyman.luckraz@papworth-tr.anglox.nhs.uk
Sharples
Linda
L
McNeil
Keith
K
Wreghitt
Tim
T
Wallwork
John
J
D000914:Antibodies, Viral / Q000032:analysis*; D001989:Bronchiolitis Obliterans / Q000453:epidemiology* / Q000401:mortality; D003586:Cytomegalovirus Infections / Q000276:immunology*; D006084:Graft Rejection / Q000453:epidemiology*; D016041:Heart-Lung Transplantation; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation; D011183:Postoperative Complications / Q000401:mortality / Q000821:virology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors
D000914:Antibodies, Viral