title: Clinical significance of quantitative cytomegalovirus detection in bronchoalveolar lavage fluid in lung transplant recipients.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) is an important pathogen after lung transplant (LTx) and may be associated with bronchiolitis obliterans syndrome (BOS). We assessed the outcome of LTx patients with CMV DNA-positive bronchoalveolar lavage (BAL) during surveillance.
  
  
  METHODS
  A single-center retrospective study was performed. Outpatients transplanted between September 2007 and February 2010, who had undergone at least 3 BALs, were included. CMV DNA load in BAL was measured by polymerase chain reaction (PCR). Monitoring of peripheral blood antigenemia was performed simultaneously.
  
  
  RESULTS
  In total, 103 LTx patients underwent 1118 BALs. During median follow-up of 639 days (interquartile range, 495-780), 53 (51%) patients exhibited at least 1 positive CMV PCR in BAL. The incidence of positive CMV PCR varied post transplantation, with 6%, 30%, and 25% of BALs testing positive at <6 months, 6-24 months, and >24 months, respectively. Neither CMV BAL positivity, positive CMV antigenemia, nor dual positivity were significantly associated with BOS-free survival during follow-up. Patients with CMV-positive BAL more frequently developed CMV antigenemia in the first year (44% vs. 5%, respectively, log-rank P < 0.001).
  
  
  CONCLUSIONS
  Detection of CMV-positive BAL after the sixth month appears common, but did not correlate with BOS-free survival after LTx in this study. An increased risk of developing blood antigenemia was observed in patients with positive CMV PCR in BAL, warranting close follow-up.
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. elli.schlischewsky@stud.mh-hannover.de
authors.forename: E
authors.initials: E
authors.lastname: Schlischewsky
authors.forename: T
authors.initials: T
authors.lastname: Fuehner
authors.forename: G
authors.initials: G
authors.lastname: Warnecke
authors.forename: T
authors.initials: T
authors.lastname: Welte
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: T
authors.initials: T
authors.lastname: Ganzenmueller
authors.forename: A
authors.initials: A
authors.lastname: Heim
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D001989:Bronchiolitis Obliterans / Q000175:diagnosis*; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology*; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D000956:Antigens, Viral; D004279:DNA, Viral