title: Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study.
abstract: BACKGROUND
  The incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was to characterise the incidence and outcomes of viral respiratory infections in LTR.
  
  
  METHODS
  Patients were seen in three contexts: study-specific screenings covering all seasons; routine post-transplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses.
  
  
  RESULTS
  One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively (p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3).
  
  
  CONCLUSIONS
  There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection.
authors.affiliation: Division of Pulmonary Medicine, University Hospitals of Geneva, , Geneva, Switzerland.
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Bridevaux
authors.forename: J-D
authors.initials: JD
authors.lastname: Aubert
authors.forename: P M
authors.initials: PM
authors.lastname: Soccal
authors.forename: J
authors.initials: J
authors.lastname: Mazza-Stalder
authors.forename: C
authors.initials: C
authors.lastname: Berutto
authors.forename: T
authors.initials: T
authors.lastname: Rochat
authors.forename: L
authors.initials: L
authors.lastname: Turin
authors.forename: S
authors.initials: S
authors.lastname: Van Belle
authors.forename: L
authors.initials: L
authors.lastname: Nicod
authors.forename: P
authors.initials: P
authors.lastname: Meylan
authors.forename: G
authors.initials: G
authors.lastname: Wagner
authors.forename: Laurent
authors.initials: L
authors.lastname: Kaiser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D018893:Bronchoalveolar Lavage; D018352:Coronavirus Infections / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D007251:Influenza, Human / Q000453:epidemiology; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018184:Paramyxoviridae Infections / Q000453:epidemiology; D010850:Picornaviridae Infections / Q000453:epidemiology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014777:Virus Diseases / Q000453:epidemiology*; D055815:Young Adult
keywords: Lung Transplantation; Respiratory Infection; Viral infection