title: Cytomegalovirus antibody status of donor/recipient does not influence the incidence of bronchiolitis obliterans syndrome in lung transplantation.
abstract: 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.
authors.affiliation: Transplant Unit, Papworth Hospital, Cambridge, UK. heyman.luckraz@papworth-tr.anglox.nhs.uk
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
authors.forename: Linda
authors.initials: L
authors.lastname: Sharples
authors.forename: Keith
authors.initials: K
authors.lastname: McNeil
authors.forename: Tim
authors.initials: T
authors.lastname: Wreghitt
authors.forename: John
authors.initials: J
authors.lastname: Wallwork
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral