1197. Respiratory virus infection and chronic lung allograft dysfunction
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDWeek 2015 Final Poster.pdf (251.8 kB)
  • Background:

    Chronic lung allograft dysfunction (CLAD) is a major cause of allograft loss post-lung transplantation. Prior studies examining the association between RVI and CLAD were limited by older diagnostics, study design, and case numbers. We examined the association between RVI and CLAD using modern diagnostic techniques in a large contemporary cohort of lung transplant recipients.

    Methods:

    We retrospectively assessed clinical variables including acute rejection, cytomegalovirus pneumonia, upper and lower RVI, and the primary endpoint of CLAD in 250 lung transplant recipients at a single university transplant program. Univariate and multivariate Cox models were used to analyze the relationship between RVI and CLAD in a time-dependent manner, incorporating different periods of risk following RVI diagnosis.

    Results:

    Fifty patients (20%) were diagnosed with CLAD at a median of 95 weeks post-transplant, and 79 (32%) had 114 episodes of RVI. In multivariate analysis, rejection and RVI were independently associated with CLAD [adjusted hazard ratio (95% confidence interval)]: 2.2 (1.2-3.9), p=0.01, and 1.9 (1.1-3.5), p=0.03, respectively. The association of RVI with CLAD was stronger the more proximate the RVI episode: 4.8 (1.9-11.6), p<0.01; 3.4 (1.5-7.5), p<0.01; 2.4 (1.2-5.0), p=0.02 in multivariate analysis for 3, 6, and 12 months following RVI, respectively. (Table 1)

    Conclusion:

    RVI is independently associated with development of CLAD, with increased risk at shorter time periods following RVI.

    Table 1: Univariate and multivariate analyses of CLAD development modeled by different risk periods following RVI

    Variable

    HR (95% CI)

    P value

    Adjusted HR (95% CI)

    P value

    RVI (“ever”)

      Age

      Bilateral transplant

      Rejection

      RVI

      CMV pneumonia

    1.01    (0.99-1.03)

    0.87 (0.39-1.93)

    2.33 (1.30-4.18)

    2.14 (1.20-3.82)

    1.44 (0.74-2.80)

    0.22

    0.73

    <0.01

    0.01

    0.28

    1.01 (0.99-1.03)

    1.15 (0.49-2.71)

    2.16 (1.18-3.93)

    1.92 (1.07-3.45)

    1.16 (0.59-2.29)

    0.27

    0.74

    0.01

    0.03

    0.67

    Differing Periods of Risk*

    RVI

       3 months

       6 months

       12 months 

    5.36 (2.20-13.04)

    3.75 (1.69-8.29)

    2.70 (1.34-5.41)

    <0.01

    <0.01

    <0.01

    4.77 (1.91-11.64)

    3.37 (1.50-7.54)

    2.44 (1.20-4.96)

    <0.01

    <0.01

    0.02

    RVI: Respiratory virus infection

    *aHR adjusted for age, bilateral transplant, rejection and CMV pneumonia

     

     

    Cynthia Fisher, MD, MPH1,2, Carl Preiksaitis, B.S.3, Erika Lease, M.D.2, Jeffrey Edelman, M.D.2, Wendy Leisenring, ScD1, Michael Boeckh, MD, FIDSA1,2, Ajit Limaye, MD, FIDSA2 and Katharine Kirby, MSc1, (1)Fred Hutchinson Cancer Research Center, Seattle, WA, (2)Department of Medicine, University of Washington, Seattle, WA, (3)University of Washington, Seattle, WA

    Disclosures:

    C. Fisher, None

    C. Preiksaitis, None

    E. Lease, None

    J. Edelman, None

    W. Leisenring, None

    M. Boeckh, None

    A. Limaye, None

    K. Kirby, None

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