Epidemiology and Immediate Indirect Effects of Respiratory Viruses in Lung Transplant Recipients: A 5‐Year Prospective Study

The epidemiology of respiratory viruses (RVs) in lung transplant recipients (LTRs) and the relationship of RVs to lung function, acute rejection (AR) and opportunistic infections in these patients are not well known. We performed a prospective cohort study (2009–2014) by collecting nasopharyngeal swabs (NPSs) from asymptomatic LTRsduring seasonal changes and from LTRswith upper respiratory tract infectious disease (URTID), lower respiratory tract infectious disease (LRTID) and AR. NPSswere analyzed by multiplex polymerase chain reaction. Overall, 1094 NPSswere collected from 98 patients with a 23.6% positivity rate and mean follow‐up of 3.4 years (interquartile range 2.5–4.0 years). Approximately half of URTIDs(47 of 97, 48.5%) and tracheobronchitis cases (22 of 56, 39.3%) were caused by picornavirus, whereas pneumonia was caused mainly by paramyxovirus (four of nine, 44.4%) and influenza (two of nine, 22.2%). In LTRswith LRTID, lung function changed significantly at 1 mo (p = 0.03) and 3 mo (p = 0.04). In a nested case–control analysis, ARwas associated with RVs (hazard ratio [HR]6.54), Pseudomonas aeruginosawas associated with LRTID(HR8.54), and cytomegalovirus (CMV)replication or disease was associated with URTID(HR2.53) in the previous 3 mo. There was no association between RVs and Aspergillusspp. colonization or infection (HR0.71). In conclusion, we documented a high incidence of RVinfections in LTRs. LRTIDproduced significant lung function abnormalities. Associations were observed between ARand RVs, between P. aeruginosacolonization or infection and LRTID, and between CMVreplication or disease and URTID. A large prospective study of the epidemiology of respiratory viruses in lung transplant recipients using molecular assays demonstrates a very high incidence of respiratory viral infection and an association between respiratory virus infectious diseases, immediate allograft dysfunction, and the development of acute rejection and opportunistic infection.