A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients

Community-acquired respiratory viral infections (RVIs) are common in lung transplant patients and may be associated with acute rejection and bronchiolitis obliterans syndrome (BOS). The use of sensitive molecular methods that can simultaneously detect a large panel of respiratory viruses may help be...

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Veröffentlicht in:Transplantation 2010-04, Vol.89 (8), p.1028-1033
Hauptverfasser: Kumar, Deepali, Husain, Shahid, Chen, Maggie Hong, Moussa, George, Himsworth, David, Manuel, Oriol, Studer, Sean, Pakstis, Diana, McCurry, Kenneth, Doucette, Karen, Pilewski, Joseph, Janeczko, Richard, Humar, Atul
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container_end_page 1033
container_issue 8
container_start_page 1028
container_title Transplantation
container_volume 89
creator Kumar, Deepali
Husain, Shahid
Chen, Maggie Hong
Moussa, George
Himsworth, David
Manuel, Oriol
Studer, Sean
Pakstis, Diana
McCurry, Kenneth
Doucette, Karen
Pilewski, Joseph
Janeczko, Richard
Humar, Atul
description Community-acquired respiratory viral infections (RVIs) are common in lung transplant patients and may be associated with acute rejection and bronchiolitis obliterans syndrome (BOS). The use of sensitive molecular methods that can simultaneously detect a large panel of respiratory viruses may help better define their effects. Lung transplant recipients undergoing serial surveillance and diagnostic bronchoalveolar lavages (BALs) during a period of 3 years were enrolled. BAL samples underwent multiplex testing for a panel of 19 respiratory viral types/subtypes using the Luminex xTAG respiratory virus panel assay. Demographics, symptoms, and forced expiratory volume in 1 sec were prospectively collected for 93 lung transplant recipients enrolled. Mean number of BAL samples was 6.2+/-3.1 per patient. A respiratory virus was isolated in 48 of 93 (51.6%) patients on at least one BAL sample. Of 81 positive samples, the viruses isolated included rhinovirus (n=46), parainfluenza 1 to 4 (n=17), coronavirus (n=11), influenza (n=4), metapneumovirus (n=4), and respiratory syncytial virus (n=2). Biopsy-proven acute rejection (> or =grade 2) or decline in forced expiratory volume in 1 sec > or =20% occurred in 16 of 48 (33.3%) patients within 3 months of RVI when compared with 3 of 45 (6.7%) RVI-negative patients within a comparable time frame (P=0.001). No significant difference was seen in incidence of acute rejection between symptomatic and asymptomatic patients. Biopsy-proven obliterative bronchiolitis or BOS was diagnosed in 10 of 16 (62.5%) patients within 1 year of infection. Community-acquired RVIs are frequently detected in BAL samples from lung transplant patients. In a significant percentage of patients, symptomatic or asymptomatic viral infection is a trigger for acute rejection and obliterative bronchiolitis/BOS.
doi_str_mv 10.1097/TP.0b013e3181d05a71
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Biopsy-proven acute rejection (&gt; or =grade 2) or decline in forced expiratory volume in 1 sec &gt; or =20% occurred in 16 of 48 (33.3%) patients within 3 months of RVI when compared with 3 of 45 (6.7%) RVI-negative patients within a comparable time frame (P=0.001). No significant difference was seen in incidence of acute rejection between symptomatic and asymptomatic patients. Biopsy-proven obliterative bronchiolitis or BOS was diagnosed in 10 of 16 (62.5%) patients within 1 year of infection. Community-acquired RVIs are frequently detected in BAL samples from lung transplant patients. In a significant percentage of patients, symptomatic or asymptomatic viral infection is a trigger for acute rejection and obliterative bronchiolitis/BOS.</abstract><cop>United States</cop><pmid>20075787</pmid><doi>10.1097/TP.0b013e3181d05a71</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Acute Disease
Adult
Biopsy
Bronchiolitis Obliterans - epidemiology
Bronchiolitis Obliterans - pathology
Bronchiolitis Obliterans - physiopathology
Bronchiolitis Obliterans - virology
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid - virology
Community-Acquired Infections - epidemiology
Community-Acquired Infections - pathology
Community-Acquired Infections - physiopathology
Community-Acquired Infections - virology
Female
Forced Expiratory Volume
Graft Rejection - epidemiology
Graft Rejection - pathology
Graft Rejection - physiopathology
Graft Rejection - virology
Humans
Immunosuppressive Agents - therapeutic use
Incidence
Lung Transplantation - adverse effects
Male
Middle Aged
Pennsylvania - epidemiology
Population Surveillance
Prospective Studies
Respiratory syncytial virus
Respiratory Tract Infections - epidemiology
Respiratory Tract Infections - pathology
Respiratory Tract Infections - physiopathology
Respiratory Tract Infections - virology
Rhinovirus
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
title A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients
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