Update on viral infections in lung transplantation

Uhlin, Michael; Mattsson, Jonas; Maeurer, Markus

doi:10.1097/mcp.0b013e3283521066

Cited by 19 publications

(8 citation statements)

References 56 publications

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“…Des prophylaxies de 12 mois sont préconisées après transplantation du poumon et du grêle. Au-delà, le risque d'infection est moindre mais constant, en particulier chez le transplanté pulmonaire [33] ou multiorganes.…”

Section: L'infection à Cytomégalovirusunclassified

Prise en charge des infections chez les adultes transplantés d’organe(s)

Schneider

Guillot

Chomette

et al. 2013

Références en Réanimation. Collection De La SRLF

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Section: L'infection à Cytomégalovirusunclassified

Prise en charge des infections chez les adultes transplantés d’organe(s)

Schneider

Guillot

Chomette

et al. 2013

Références en Réanimation. Collection De La SRLF

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“…Studies have demonstrated a higher prevalence of SAGs pre-transplant in patients with CF and IPF compared to patients with other conditions such as COPD, whereas other studies have shown this can lead to the expansion of auto-reactive lymphocytes. Individuals with these diseases have the highest prevalence of SAGs pre-LTX compared to patients with other diseases such as COPD and alpha-1 anti-trypsin deficiency (89,(94)(95)(96).…”

Section: Pathophysiology Of Amrmentioning

confidence: 99%

Acute rejection

Benzimra¹,

Calligaro²,

Glanville³

2017

J. Thorac. Dis.

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Despite induction immunosuppression and the use of aggressive maintenance immunosuppressive regimens, acute allograft rejection following lung transplantation is still a problem with important diagnostic and therapeutic challenges. As well as causing early graft loss and mortality, acute rejection also initiates the chronic alloimmune responses and airway-centred inflammation that predispose to bronchiolitis obliterans syndrome (BOS), also known as chronic lung allograft dysfunction (CLAD), which is a major source of morbidity and mortality after lung transplantation. Cellular responses to human leukocyte antigens (HLAs) on the allograft have traditionally been considered the main mechanism of acute rejection, but the influence of humoral immunity is increasingly recognised. As with other several other solid organ transplants, antibody-mediated rejection (AMR) is now a well-accepted and distinct clinical entity in lung transplantation. While acute cellular rejection (ACR) has defined histopathological criteria, transbronchial biopsy is less useful in AMR and its diagnosis is complicated by challenges in the measurement of antibodies directed against donor HLA, and a determination of their significance. Increasing awareness of the importance of non-HLA antigens further clouds this issue. Here, we review the pathophysiology, diagnosis, clinical presentation and treatment of ACR and AMR in lung transplantation, and discuss future potential biomarkers of both processes that may forward our understanding of these conditions.

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“…On the other hand, it is necessary to highlight the role of this family of viruses in the pathogenesis of lower respiratory tract infections both in the immunocompromised and in the immunocompetent host. In the latter group, the infection usually has an asymptomatic or mononucleosis-like syndrome course but, occasionally, a primary cytomegalovirus (CMV) infection can evolve into more severe organ-specific manifestations [47][48][49][50][51][52]. Furthermore, as previously mentioned, many patients may display a colonisation from herpes viruses and, thus, a positive PCR might not be sufficient to distinguish asymptomatic colonisation from an active infection.…”

Section: Discussionmentioning

confidence: 99%

Use of an innovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: a pilot study

et al. 2019

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Background: The aetiology of lower respiratory tract infections is challenging to investigate. Despite the wide array of diagnostic tools, invasive techniques, such as bronchoalveolar lavage (BAL), are often required to obtain adequate specimens. PneumoniaCheck TM is a new device that collects aerosol particles from cough, allowing microbiological analyses. Up to now it has been tested only for bacteria detection, but no study has investigated its usefulness for virus identification. Methods: In this pilot study we included 12 consecutive patients with pneumonia. After testing cough adequacy via a peak flow meter, a sampling with PneumoniaCheck TM was collected and a BAL was performed in each patient. Microbiological analyses for virus identification were performed on each sample and concordance between the two techniques was tested (sensitivity, specificity and positive/negative predictive values), taking BAL results as reference. Results: BAL was considered adequate in 10 patients. Among them, a viral pathogen was identified by PneumoniaCheck TM 6 times, each on different samples, whereas BAL allowed to detect the presence of a virus on 7 patients (14 positivities). Overall, the specificity for PneumoniaCheck TM to detect a virus was 100%, whereas the sensitivity was 66%. When considering only herpes viruses, PneumoniaCheck TM showed a lower sensitivity, detecting a virus in 1/4 of infected patients (25%). Conclusions: In this pilot study PneumoniaCheck TM showed a good correlation with BAL for non-herpes virologic identification in pneumonia patients, providing excellent specificity. Further studies on larger population are needed to confirm these results and define its place in the panorama of rapid diagnostic tests for lower respiratory tract infections.

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Update on viral infections in lung transplantation

Abstract: Pharmacological immune suppression, the genetic makeup of the patient as well as concurrent viral infections impact on the successful outcome of lung transplantation and call for more detailed immune-guided diagnostics and therapy.

Cited by 19 publications

References 56 publications

Prise en charge des infections chez les adultes transplantés d’organe(s)

Prise en charge des infections chez les adultes transplantés d’organe(s)

Acute rejection

Use of an innovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: a pilot study

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