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Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome.
J Heart Lung Transplant. 2009 Feb; 28(2):163-9.JH

Abstract

BACKGROUND

Among the many potential risk factors influencing the development of bronchiolitis obliterans syndrome (BOS), acute cellular rejection is the most frequently identified. Despite the unique susceptibility of the lung allograft to pathogens, the association with respiratory tract infections remains unclear. In this study we analyze the role respiratory tract infections have on the development of BOS after lung transplantation.

METHODS

Data from a single center were analyzed from 161 lung recipients transplanted from November 1990 to November 2005, and who survived >180 days. Univariate and multivariate Cox regression analyses were performed using BOS development and the time-scale was reported with hazard ratios (HRs) and confidence intervals (CIs).

RESULTS

Significant findings by univariate analysis per 100 patient-days prior to BOS onset included acute rejection, cytomegalovirus (CMV) pneumonitis, Gram-negative respiratory tract infections, Gram-positive respiratory tract infections and fungal pneumonias. Multivariate analysis indicated acute rejection, Gram-negative, Gram-positive and fungal pneumonias with HRs (CI) of 84 (23 to 309), 6.6 (1.2 to 37), 6,371 (84 to 485,000) and 314 (53 to 1,856) to be associated with BOS, respectively. Acute rejection, CMV pneumonitis, Gram-positive pneumonia and fungal pneumonitis in the first 100 days had HRs (CI) of 1.8 (1.1 to 3.2), 3.1 (1.3 to 6.9), 3.8 (1.5 to 9.4) and 2.1 (1.1 to 4.0), respectively, and acute rejection and fungal pneumonitis in the late post-operative period with HRs (CI) of 2.3 (1.2 to 4.4) and 1.5 (1.1 to 1.9), respectively.

CONCLUSIONS

In addition to acute rejection, pneumonias with GP, GN and fungal pathogens occurring prior to BOS are independent determinants of chronic allograft dysfunction. Early recognition and treatment of these pathogens in lung transplant recipients may improve long-term outcomes after transplantation.

Authors+Show Affiliations

Texas Transplant Center, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0772, USA. vgvalent@utmb.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19201342

Citation

Valentine, Vincent G., et al. "Effect of Etiology and Timing of Respiratory Tract Infections On Development of Bronchiolitis Obliterans Syndrome." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 28, no. 2, 2009, pp. 163-9.
Valentine VG, Gupta MR, Walker JE, et al. Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2009;28(2):163-9.
Valentine, V. G., Gupta, M. R., Walker, J. E., Seoane, L., Bonvillain, R. W., Lombard, G. A., Weill, D., & Dhillon, G. S. (2009). Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 28(2), 163-9. https://doi.org/10.1016/j.healun.2008.11.907
Valentine VG, et al. Effect of Etiology and Timing of Respiratory Tract Infections On Development of Bronchiolitis Obliterans Syndrome. J Heart Lung Transplant. 2009;28(2):163-9. PubMed PMID: 19201342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome. AU - Valentine,Vincent G, AU - Gupta,Meera R, AU - Walker,James E,Jr AU - Seoane,Leonardo, AU - Bonvillain,Ryan W, AU - Lombard,Gisele A, AU - Weill,David, AU - Dhillon,Gundeep S, PY - 2008/04/26/received PY - 2008/07/13/revised PY - 2008/11/18/accepted PY - 2009/2/10/entrez PY - 2009/2/10/pubmed PY - 2009/7/30/medline SP - 163 EP - 9 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 28 IS - 2 N2 - BACKGROUND: Among the many potential risk factors influencing the development of bronchiolitis obliterans syndrome (BOS), acute cellular rejection is the most frequently identified. Despite the unique susceptibility of the lung allograft to pathogens, the association with respiratory tract infections remains unclear. In this study we analyze the role respiratory tract infections have on the development of BOS after lung transplantation. METHODS: Data from a single center were analyzed from 161 lung recipients transplanted from November 1990 to November 2005, and who survived >180 days. Univariate and multivariate Cox regression analyses were performed using BOS development and the time-scale was reported with hazard ratios (HRs) and confidence intervals (CIs). RESULTS: Significant findings by univariate analysis per 100 patient-days prior to BOS onset included acute rejection, cytomegalovirus (CMV) pneumonitis, Gram-negative respiratory tract infections, Gram-positive respiratory tract infections and fungal pneumonias. Multivariate analysis indicated acute rejection, Gram-negative, Gram-positive and fungal pneumonias with HRs (CI) of 84 (23 to 309), 6.6 (1.2 to 37), 6,371 (84 to 485,000) and 314 (53 to 1,856) to be associated with BOS, respectively. Acute rejection, CMV pneumonitis, Gram-positive pneumonia and fungal pneumonitis in the first 100 days had HRs (CI) of 1.8 (1.1 to 3.2), 3.1 (1.3 to 6.9), 3.8 (1.5 to 9.4) and 2.1 (1.1 to 4.0), respectively, and acute rejection and fungal pneumonitis in the late post-operative period with HRs (CI) of 2.3 (1.2 to 4.4) and 1.5 (1.1 to 1.9), respectively. CONCLUSIONS: In addition to acute rejection, pneumonias with GP, GN and fungal pathogens occurring prior to BOS are independent determinants of chronic allograft dysfunction. Early recognition and treatment of these pathogens in lung transplant recipients may improve long-term outcomes after transplantation. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/19201342/Effect_of_etiology_and_timing_of_respiratory_tract_infections_on_development_of_bronchiolitis_obliterans_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(08)01706-3 DB - PRIME DP - Unbound Medicine ER -