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.

In 2003, Khalifah et al 6 presented data suggesting that respiratory viral infections are a distinct risk for BOS. More recently, Allyn et al 19 reported that CLAD development was hastened by viral pneumonia defined as symptomatic viral infection and a radiographic infiltrate without a clear alternative explanation. Their study included BAL samples, expectorated sputum and tracheal suction, as well as NPH wash samples, primarily analyzed with cultures from 2000 to 2008, and with PCR from 2009 onward. It is indicated that a majority of the samples were BAL samples, and the main detection method was culture-based, which might explain the lower proportion of VRTI-positive subjects (25%) compared with our study (52%) and other prospective studies (51-61%). 7,20-22 Fisher et al 12 published a retrospective study of 250 patients with at least 1-year follow-up, in which tests for VRTI were performed upon clinical suspicion but no surveillance testing was carried out. The samples were tested using different methods including PCR, fluorescence microscopy and cultures. They found a time-dependent relationship with CLAD development at 3, 6, and 12 months after VRTI, with an HR declining with time after the event. They also showed that AR was a significant risk factor for CLAD development.