Upper and Lower Respiratory Tract Viral Infections and Acute Graft Rejection in Lung Transplant Recipients

被引:58
|
作者
Soccal, P. M. [1 ,2 ]
Aubert, J. -D. [7 ]
Bridevaux, P. -O.
Garbino, J. [3 ]
Thomas, Y. [3 ,4 ,5 ,6 ]
Rochat, T.
Rochat, T. S. [3 ,4 ,5 ,6 ]
Meylan, P. [8 ,9 ]
Tapparel, C. [3 ,4 ,5 ,6 ]
Kaiser, L. [3 ,4 ,5 ,6 ]
机构
[1] Univ Hosp Geneva, Dept Internal Med, Div Pulm Med, CH-1211 Geneva 14, Switzerland
[2] Univ Hosp Geneva, Clin Thorac Surg, CH-1211 Geneva 14, Switzerland
[3] Univ Hosp Geneva, Div Infect Dis, CH-1211 Geneva 14, Switzerland
[4] Univ Hosp Geneva, Virol Lab, CH-1211 Geneva 14, Switzerland
[5] Univ Hosp Geneva, Div Lab Med, CH-1211 Geneva 14, Switzerland
[6] Univ Geneva, Sch Med, CH-1211 Geneva, Switzerland
[7] Univ Lausanne Hosp, Div Pulm Med, Lausanne, Switzerland
[8] Univ Lausanne Hosp, Inst Microbiol, Lausanne, Switzerland
[9] Univ Lausanne Hosp, Div Infect Dis, Lausanne, Switzerland
基金
瑞士国家科学基金会;
关键词
HUMAN METAPNEUMOVIRUS INFECTION; PARAINFLUENZA VIRUS-INFECTION; BRONCHIOLITIS OBLITERANS; CLINICAL IMPACT; BRONCHOALVEOLAR LAVAGE; SYNCYTIAL VIRUS; EPIDEMIOLOGY; INFLUENZA; DIAGNOSIS; ETIOLOGY;
D O I
10.1086/653529
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Lung transplant recipients are frequently exposed to respiratory viruses and are particularly at risk for severe complications. The aim of this study was to assess the association among the presence of a respiratory virus detected by molecular assays in bronchoalveolar lavage (BAL) fluid, respiratory symptoms, and acute rejection in adult lung transplant recipients. Methods. Upper (nasopharyngeal swab) and lower (BAL) respiratory tract specimens from 77 lung transplant recipients enrolled in a cohort study and undergoing bronchoscopy with BAL and transbronchial biopsies were screened using 17 different polymerase chain reaction-based assays. Results. BAL fluid and biopsy specimens from 343 bronchoscopic procedures performed in 77 patients were analyzed. We also compared paired nasopharyngeal and BAL fluid specimens collected in a subgroup of 283 cases. The overall viral positivity rate was 29.3% in the upper respiratory tract specimens and 17.2% in the BAL samples (). We observed a significant association P < .001 between the presence of respiratory symptoms and positive viral detection in the lower respiratory tract (Pp. 012). Conversely, acute rejection was not associated with the presence of viral infection (odds ratio, 0.41; 95% confidence interval, 0.20-0.88). The recovery of lung function was significantly slower when acute rejection and viral infection were both present. Conclusions. A temporal relationship exists between acute respiratory symptoms and positive viral nucleic acid detection in BAL fluid from lung transplant recipients. We provide evidence suggesting that respiratory viruses are not associated with acute graft rejection during the acute phase of infection.
引用
收藏
页码:163 / 170
页数:8
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