Chronic Lung Allograft Dysfunction is Associated with Acute Rejection and High Levels of Cytomegalovirus Load in Blood (but Not in Lung)

Abstract

Purpose The potential association of human cytomegalovirus (HCMV) infection and acute rejection with the occurrence of chronic lung allograft dysfunction (CLAD) was analysed in lung transplant recipients not receiving anti-HCMV prophylaxis, but followed with a pre-emptive strategy. Methods We analysed 129 lung transplant recipients (Feb 2004 -feb 2018). HCMV infection in blood was monitored by HCMV DNA (101 patients) or pp65-antigenemia (28 patients, with retrospective confirmation of HCMV DNA), and in broncoalveolar lavage (BAL) by HCMV DNA. Protocol cut-off values for pre-emptive treatment initiation with Gancyclovir (GCV) or valganciclovir (VGCV) were; 100 pp65-positive /200,000 WBC or 300,000 HCMV DNA copies/ml blood, 100.000 HCMV DNA copies/ml BAL. Results HCMV infection was detected in 121 (94%) patients: 52 (40%) patients remained asymptomatic and resolved without treatment (peak HCMV DNA: 2,930, [ 100.000,10,000-100,000 or Conclusion By means of this retrospective analysis we can state that high levels of HCMV in blood, besides the occurrence of acute rejection, are associated with higher risk of CLAD occurrence. Although we cannot prove a causal relationship between HCMV load in blood and CLAD, on this basis cut-off for pre-emptive treatment must be lowered in order to decrease a potential risk for CLAD occurrence.