Viral Respiratory Tract Infection During the First Postoperative Year Is a Risk Factor for Chronic Rejection After Lung Transplantation

Magnusson, Jesper; Westin, Johan; Andersson, Lars-Magnus; Lindh, Magnus; Brittain-Long, Robin; Nordén, Rickard; Riise, Gerdt C.

At the end of follow-up, 48 patients had been diagnosed with CLAD (Table 2 ). Of these, 11 were predominantly restrictive and 37 were predominantly obstructive. A total of 48 patients suffered organ loss, of which 42 patients died and 6 had a retransplantation. Twelve of the deaths occurred during the first year. The major cause for organ loss was CLAD (n = 25), and other significant causes were infections (n = 7) and malignancy (n = 6). Chronic lung allograft dysfunction development during the follow-up period was more common among the VRTI positive subjects (P = 0.005) ( Table 2) , and it was significantly more common that CLAD was cause of organ loss among those who had suffered from a VRTI (P = 0.008). We found no significant difference regarding graft survival at the end of follow-up between patients with and without VRTIs (P = 0.84) ( Table 2 ). The VRTI-positive subjects had a significantly higher hazard ratio (HR) for CLAD development in multivariate analysis (P = 0.041) ( Table 3 ), but we found no significant difference in time until graft loss (P = 0.86). However, among those who suffered from organ loss, time between CLAD development and organ loss were significantly longer for those who had 1 or more VRTI before developing CLAD, compared with those who had none (P = 0.021). Bacterial (P = 0.013) and fungal (P = 0.001) infections were associated with shorter time to graft loss.