Quantification of Torque Teno Virus and Epstein-Barr Virus Is of Limited Value for Predicting the Net State of Immunosuppression After Lung Transplantation

Nordén, Rickard; Magnusson, Jesper; Lundin, Anna; Tang, Ka-Wei; Nilsson, Staffan; Lindh, Magnus; Andersson, Lars-Magnus; Riise, Gerdt C; Westin, Johan

All included subjects underwent follow-up (FU) visits at 1, 2, 3, 4.5, 6, 9, 12, 18, and 24 months after transplantation. At every FU visit, whole blood, serum, and nasopharyngeal samples (NPH) were collected. Protocol bronchoscopies were performed at 1, 3, and 12 months post-transplantation and when indicated based on clinical presentation. Bronchoalveolar lavage (BAL) samples were collected at every bronchoscopy. All BAL samples underwent direct microscopy for early detection of Aspergillus hyphae and were cultured for bacteria and fungi and tested for Legionella pneumophila, Pneumocystis jirovecii, and human cytomegalovirus (CMV) using real-time polymerase chain reaction (PCR). BAL samples from patients with cystic fibrosis were routinely cultured for Mycobacterium tuberculosis and atypical Mycobacteria. Bacterial and fungal culture testing from blood, urine, and sputum was performed upon suspicion of infection. NPH and BAL samples from every FU visit, as well as additional NPH samples obtained upon suspicion of airway infection between scheduled FU visits, were analyzed by multiplex real-time PCR for detection of airway pathogens. Serum samples obtained at pretransplant evaluation were used for TTV-DNA and EBV-DNA quantification. For quantification of TTV and EBV during FU, serum and whole blood samples were used, respectively.