Graft Loss and CLAD-Onset Is Hastened by Viral Pneumonia After Lung Transplantation

Autor: Michael Y. Shino, Patil Injean, Chi-Hong Tseng, David J. Ross, Erin Lindsey Duffy, Bernard M. Kubak, Aric L. Gregson, Rajan Saggar, Abbas Ardehali, John A. Belperio, Romney M. Humphries, Paul R Allyn, Joseph P. Lynch, S. Samuel Weigt
Rok vydání: 2016
Předmět:
Graft Rejection
Male
medicine.medical_treatment
030230 surgery
Medical and Health Sciences
Gastroenterology
0302 clinical medicine
2.2 Factors relating to the physical environment
Viral
Aetiology
Respiratory system
Lung
Hazard ratio
Middle Aged
Allografts
Community-Acquired Infections
Infectious Diseases
medicine.anatomical_structure
Virus Diseases
Viral pneumonia
Pneumonia & Influenza
Respiratory
Respiratory virus
Female
medicine.symptom
Infection
Lung Transplantation
Adult
medicine.medical_specialty
Pneumonia
Viral
Asymptomatic
Article
03 medical and health sciences
Internal medicine
medicine
Humans
Lung transplantation
Proportional Hazards Models
Aged
Transplantation
business.industry
Prevention
Pneumonia
Organ Transplantation
medicine.disease
Virology
030228 respiratory system
Chronic Disease
Surgery
business
Zdroj: Transplantation, vol 100, iss 11
Transplantation
ISSN: 0041-1337
Popis: BackgroundCommunity-acquired respiratory virus (CARV) infections occur frequently after lung transplantation and may adversely impact outcomes. We hypothesized that while asymptomatic carriage would not increase the risk of chronic lung allograft dysfunction (CLAD) and graft loss, severe infection would.MethodsAll lung transplant cases between January 2000 and July 2013 performed at our center were reviewed for respiratory viral samples. Each isolation of virus was classified according to clinical level of severity: asymptomatic, symptomatic without pneumonia, and viral pneumonia. Multivariate Cox modeling was used to assess the impact of CARV isolation on progression to CLAD and graft loss.ResultsFour thousand four hundred eight specimens were collected from 563 total patients, with 139 patients producing 324 virus-positive specimens in 245 episodes of CARV infection. Overall, the risk of CLAD was elevated by viral infection (hazard ratio [HR], 1.64; P < 0.01). This risk, however, was due to viral pneumonia alone (HR, 3.94; P < 0.01), without significant impact from symptomatic viral infection (HR, 0.97; P = 0.94) nor from asymptomatic viral infection (HR, 0.99; P = 0.98). The risk of graft loss was not increased by asymptomatic CARV infection (HR, 0.74; P = 0.37) nor symptomatic CARV infection (HR, 1.39; P = 0.41). Viral pneumonia did, however, significantly increase the risk of graft loss (HR, 2.78; P < 0.01).ConclusionsWith respect to CARV, only viral pneumonia increased the risk of both CLAD and graft loss after lung transplantation. In the absence of pneumonia, respiratory viruses had no impact on measured outcomes.
Databáze: OpenAIRE
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