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Clinical significance of quantitative cytomegalovirus detection in bronchoalveolar lavage fluid in lung transplant recipients
Author(s) -
Schlischewsky E.,
Fuehner T.,
Warnecke G.,
Welte T.,
Haverich A.,
Ganzenmueller T.,
Heim A.,
Gottlieb J.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12015
Subject(s) - medicine , bronchoalveolar lavage , interquartile range , bronchiolitis obliterans , gastroenterology , lung transplantation , cytomegalovirus , immunology , human cytomegalovirus , lung , herpesviridae , virus , viral disease
Objectives Cytomegalovirus ( CMV ) is an important pathogen after lung transplant ( LT x) and may be associated with bronchiolitis obliterans syndrome ( BOS ). We assessed the outcome of LT x patients with CMV DNA ‐positive bronchoalveolar lavage ( BAL ) during surveillance. Methods A single‐center retrospective study was performed. Outpatients transplanted between September 2007 and February 2010, who had undergone at least 3 BAL s, were included. CMV DNA load in BAL was measured by polymerase chain reaction ( PCR ). Monitoring of peripheral blood antigenemia was performed simultaneously. Results In total, 103 LT x patients underwent 1118 BAL s. During median follow‐up of 639 days (interquartile range, 495–780), 53 (51%) patients exhibited at least 1 positive CMV PCR in BAL . The incidence of positive CMV PCR varied post transplantation, with 6%, 30%, and 25% of BAL s testing positive at <6 months, 6–24 months, and >24 months, respectively. Neither CMV BAL positivity, positive CMV antigenemia, nor dual positivity were significantly associated with BOS ‐free survival during follow‐up. Patients with CMV ‐positive BAL more frequently developed CMV antigenemia in the first year (44% vs. 5%, respectively, log‐rank P < 0.001). Conclusions Detection of CMV ‐ positive BAL after the sixth month appears common, but did not correlate with BOS ‐free survival after LT x in this study. An increased risk of developing blood antigenemia was observed in patients with positive CMV PCR in BAL , warranting close follow‐up.