Respiratory Viruses at Time of Lung Transplant and the Relationship to Primary Graft Dysfunction

Primary graft dysfunction (PGD) is a form of immediate post-transplant acute lung injury associated with increased risk of mortality, and it is possible that respiratory viruses (RVs) at the time of transplant may augment this.

We retrospectively studied all adult lung transplant recipients transplanted in our program from 2017 to 2020, with a primary outcome of grade 3 PGD (PGD3), defined as edema on chest X-ray and arterial oxygen/fraction of inspired oxygen ratio <200 at 48- or 72-h post-transplant. RV status was assessed by nucleic acid amplification test on routine bronchoscopic specimens performed on day 1 post-transplant. During the pandemic, severe acute respiratory syndrome coronavirus 2 was sampled in all donors and recipients and precluded transplant. Chi-square tests and logistic regression were used to evaluate the association between RV status and PGD3.

A total of 229 patients met criteria for inclusion, and 63 patients (27%) were RV+. Twenty-seven patients (12%) developed PGD3 at 48- or 72-h. RV+ was not associated with a difference in PGD3 risk adjusted for donor age, use of cardiopulmonary bypass, or body mass index >30 (odds ratio 0.93 [95% confidence interval 0.38-2.49; p = 0.8845]).

Perioperative RVs were not associated with a difference in the risk of PGD3 in our cohort. This may have implications for donor and recipient selection and preoperative evaluation.