169 Clinical Significance of Cytomegalovirus (CMV) Detected by RT-PCR in Bronchoalveolar-Lavage Fluid of Stable Lung Transplant Recipients

Abstract

Purpose: Cytomegalovirus (CMV) may play a major role in the development of bronchiolitis obliterans syndrome (BOS). Study aim was to assess the outcome of CMV-DNA positive LTx outpatients in bronchoalveolar lavage (BAL) during surveillance. Methods and Materials: A single-center retrospective cohort study was performed between 9-2007 and 2-2010. Pts who underwent at least 3 BAL (surveillance months 3, 6 and 12 plus indication tests) were included. CMV-DNA load in BAL by PCR had a cut-off of 500 copies/mL. CMV pp65 antigenemia was detected in peripheral blood leukocytes. A 3-months prophylaxis with ganciclovir/ valgangciclovir was applied in all but low-risk pts. No antiviral treatment was administered in case of an isolated positive CMV-PCR in BAL. Results: 103 LTx-pts underwent 1100 BAL (87% SSLTx, median 49 years, 41% female, 32% COPD, 23% IPF, 28% CF). F/u was median 639 (interquartiles 495-780) d. 155 BAL (14%) were CMV-PCR pos of whom 23 (2%) % had a simultaneous CMV-antigenemia in blood. 1, 17, 28, 29 and 21 % of BALs were CMV-PCR-pos in months 0-3, 4-6, 7-12, 12-24 and 24 respectively. 53 (51%) of all pts had at least one positive CMV-PCR in BAL during f/u. A CMV-seropositive donor proved to be a independent risk factor for CMV-positivity in BAL (p 0.001 hazard ratio 1.8). 7 patients died median 494 (IQR 482-641) d after LTx, no death was CMV-related. 58/103 (56%) pts underwent a course of rejection treatment during the first year. Neither CMV-BAL-positivity, positive antigenemia nor positivity in both tests had a significant effect on rejection or BOS-free survival (p 0.055 for the latter). Pts with BAL-CMV detection developed significantly more frequently CMV-antigenemia in blood after one year (44 vs. 5% respectively, log-rank p 0.001). Conclusions: Detection of CMV-BAL is a frequent phenomenon after LTx after the first 3 postoperative months. Detection of CMV in BAL by PCR did not correlate with rejection free and BOS free survival. We conclude that monitoring CMV-DNA in BAL is of limited clinical value after LTx.