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Published ahead of print on August 5, 2004, doi:10.1164/rccm.200310-1405OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 10, November 2004, 1120-1123

A more recent version of this article appeared on November 15, 2004
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Submitted on October 14, 2003
Accepted on July 28, 2004

Treated Cytomegalovirus Pneumonia is Not Associated with Bronchiolitis Obliterans Syndrome

Michael Tamm1, Christina L Aboyoun1, Prashant N Chhajed1*, Stephen Rainer1, Monique A Malouf1, and Allan R Glanville1

1 The Lung Transplant Unit, St. Vincent's Hospital, Sydney, NSW, Australia

* To whom correspondence should be addressed. E-mail: PChhajed{at}uhbs.ch.

The association of Cytomegalovirus infection with the development of bronchiolitis obliterans syndrome is unclear. We studied 341 lung transplant recipients to assess whether histopathologically diagnosed Cytomegalovirus pneumonia treated with Ganciclovir was a risk factor for development of bronchiolitis obliterans syndrome and patient survival. We also analyzed the relationship between Cytomegalovirus donor/recipient serological status and bronchiolitis obliterans syndrome plus the temporal association between acute rejection and Cytomegalovirus pneumonia. Freedom from bronchiolitis obliterans syndrome for patients with (n=151) and without (n=190) Cytomegalovirus pneumonia was 83% and 90% (1-year), 52% and 56% (3-years) and 29% and 38% (5-years) respectively (p=0.2660). Cumulative survival of patients with and without Cytomegalovirus pneumonia was 90% and 93% (1-year), 70% and 74% (3-years) and 58% and 63% (5-years) respectively (p=0.1811). There were no significant differences in either development of bronchiolitis obliterans syndrome or patient survival with any combination of donor/recipient serostatus for Cytomegalovirus. Acute rejection occurred in the month preceding Cytomegalovirus pneumonia in 62/193(32%) cases. Histopathologically confirmed Cytomegalovirus pneumonia treated with Ganciclovir is not a risk factor for bronchiolitis obliterans syndrome or patient survival, nor is any particular Cytomegalovirus serological donor/recipient group. Cytomegalovirus pneumonia often follows acute rejection, perhaps as a result of augmented immunosuppression.
Key words: Cytomegalovirus, lung transplant, Bronchiolitis Obliterans Syndrome




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