title: A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients.
abstract: BACKGROUND
  Community-acquired respiratory viral infections (RVIs) are common in lung transplant patients and may be associated with acute rejection and bronchiolitis obliterans syndrome (BOS). The use of sensitive molecular methods that can simultaneously detect a large panel of respiratory viruses may help better define their effects.
  
  
  METHODS
  Lung transplant recipients undergoing serial surveillance and diagnostic bronchoalveolar lavages (BALs) during a period of 3 years were enrolled. BAL samples underwent multiplex testing for a panel of 19 respiratory viral types/subtypes using the Luminex xTAG respiratory virus panel assay.
  
  
  RESULTS
  Demographics, symptoms, and forced expiratory volume in 1 sec were prospectively collected for 93 lung transplant recipients enrolled. Mean number of BAL samples was 6.2+/-3.1 per patient. A respiratory virus was isolated in 48 of 93 (51.6%) patients on at least one BAL sample. Of 81 positive samples, the viruses isolated included rhinovirus (n=46), parainfluenza 1 to 4 (n=17), coronavirus (n=11), influenza (n=4), metapneumovirus (n=4), and respiratory syncytial virus (n=2). Biopsy-proven acute rejection (> or =grade 2) or decline in forced expiratory volume in 1 sec > or =20% occurred in 16 of 48 (33.3%) patients within 3 months of RVI when compared with 3 of 45 (6.7%) RVI-negative patients within a comparable time frame (P=0.001). No significant difference was seen in incidence of acute rejection between symptomatic and asymptomatic patients. Biopsy-proven obliterative bronchiolitis or BOS was diagnosed in 10 of 16 (62.5%) patients within 1 year of infection.
  
  
  CONCLUSIONS
  Community-acquired RVIs are frequently detected in BAL samples from lung transplant patients. In a significant percentage of patients, symptomatic or asymptomatic viral infection is a trigger for acute rejection and obliterative bronchiolitis/BOS.
authors.affiliation: Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada. deepali.kumar@ualberta.ca
authors.forename: Deepali
authors.initials: D
authors.lastname: Kumar
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Maggie Hong
authors.initials: MH
authors.lastname: Chen
authors.forename: George
authors.initials: G
authors.lastname: Moussa
authors.forename: David
authors.initials: D
authors.lastname: Himsworth
authors.forename: Oriol
authors.initials: O
authors.lastname: Manuel
authors.forename: Sean
authors.initials: S
authors.lastname: Studer
authors.forename: Diana
authors.initials: D
authors.lastname: Pakstis
authors.forename: Kenneth
authors.initials: K
authors.lastname: McCurry
authors.forename: Karen
authors.initials: K
authors.lastname: Doucette
authors.forename: Joseph
authors.initials: J
authors.lastname: Pilewski
authors.forename: Richard
authors.initials: R
authors.lastname: Janeczko
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000821:virology*; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000821:virology*; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000821:virology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology / Q000821:virology*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents