A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients.
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.
Kumar
Deepali
D
Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada. deepali.kumar@ualberta.ca
Husain
Shahid
S
Chen
Maggie Hong
MH
Moussa
George
G
Himsworth
David
D
Manuel
Oriol
O
Studer
Sean
S
Pakstis
Diana
D
McCurry
Kenneth
K
Doucette
Karen
K
Pilewski
Joseph
J
Janeczko
Richard
R
Humar
Atul
A
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
D007166:Immunosuppressive Agents