Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome

Valentine, Vincent G., Gupta, Meera R., Walker Jr, James E., Seoane, Leonardo, Bonvillain, Ryan W., Lombard, Gisele A., Weill, David and Dhillon, Gundcep S. (2009) Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome. Journal of Heart and Lung Transplantation, 28 2: 163-169. doi:10.1016/j.healun.2008.11.907

Author Valentine, Vincent G.
Gupta, Meera R.
Walker Jr, James E.
Seoane, Leonardo
Bonvillain, Ryan W.
Lombard, Gisele A.
Weill, David
Dhillon, Gundcep S.
Title Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome
Journal name Journal of Heart and Lung Transplantation   Check publisher's open access policy
ISSN 1053-2498
Publication date 2009-02
Sub-type Article (original research)
DOI 10.1016/j.healun.2008.11.907
Open Access Status Not Open Access
Volume 28
Issue 2
Start page 163
End page 169
Total pages 7
Place of publication Philadelphia, PA United States
Publisher Elsevier
Language eng
Formatted abstract

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.


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).


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.


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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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