Epidemiology and Immediate Indirect Effects of Respiratory Viruses in Lung Transplant Recipients: A 5-Year Prospective Study.
The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009-2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRs during seasonal changes and from LTRs with upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSs were analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSs were collected from 98 patients with a 23.6% positivity rate and mean follow-up of 3.4 years (interquartile range 2.5-4.0 years). Approximately half of URTIDs (47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRs with LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case-control analysis, AR was associated with RVs (hazard ratio [HR] 6.54), Pseudomonas aeruginosa was associated with LRTID (HR 8.54), and cytomegalovirus (CMV) replication or disease was associated with URTID (HR 2.53) in the previous 3 mo. There was no association between RVs and Aspergillus spp. colonization or infection (HR 0.71). In conclusion, we documented a high incidence of RV infections in LTRs. LRTID produced significant lung function abnormalities. Associations were observed between AR and RVs, between P. aeruginosa colonization or infection and LRTID, and between CMV replication or disease and URTID.
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.
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Peghin
Transplantation & Clinical Virology, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.|Division Infection Diagnostics, Department Biomedicine (Haus Petersplatz), University of Basel, Basel, Switzerland.|Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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Hirsch
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.
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Len
Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.|Department of Microbiology, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
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Codina
Department of Pulmonology and Lung Transplant Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Berastegui
Department of Pulmonology and Lung Transplant Unit, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Sáez
Department of Thoracic Surgery, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
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Solé
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.
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Cabral
Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.|Lung Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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Solé
Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.|Division of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
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Zurbano
Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.|Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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López-Medrano
Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.|CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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Román
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain.|Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain.
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Gavaldá
D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014780:Viruses / Q000472:pathogenicity*
clinical research/practice; complication: infectious; infection and infectious agents; infectious disease; lung disease: infectious; lung transplantation/pulmonology; rejection: acute; viral; viral: influenza