Incidental Detection of Respiratory Viruses in Lung Transplant Donor-Recipient Pairs: Exploratory Associations with Clinical Outcomes in a Post Hoc Analysis

Background: Infections caused by community-acquired respiratory viruses (CARV) are very common among lung transplant recipients and have been linked to acute rejection and chronic lung allograft dysfunction (CLAD). However, the clinical relevance of CARV detection in donor-recipient pairs at the time of lung transplantation remains unclear. Methods: Post hoc analysis of the Pneumoarray study, evaluating the clinical significance of incidentally detected CARV identified by syndromic molecular panels (PNplus) in BAL samples collected 72 h after transplantation from donors and recipients. Results: Among 53 donor-recipient pairs, CARV were identified in 7 (13.2%) and 11 (20.8%) BAL samples from donors and recipients, respectively. Unadjusted analyses showed a link between CARV PNplus positivity in donor samples and longer hospitalization (Δ+30.3 days, 95% CI 7.1–53.5; p = 0.011). Any CARV PNplus positivity during the transplant episode also indicated a potential link with longer hospital stays (Δ+19.2 days, 95% CI 1.4–37.0; p = 0.035). Donor CARV PNplus positivity showed a signal suggesting a potential association with higher odds of CLAD within 12 months (OR 8.40, 95% CI 0.84–83.89; p = 0.030). CARV PNplus positivity in the recipient for rhinovirus indicated a potential link with baseline lung allograft dysfunction (p = 0.016), while no other relationships were observed between clinical outcomes and being PNplus positive for a viral pathogen. Conclusion: CARV genome detection in donor BAL samples was numerically associated with longer posttransplant hospitalization, and a potential signal between rhinovirus detection in recipient BAL and baseline lung allograft dysfunction was observed. However, these findings should be regarded as exploratory and hypothesis-generating, and they do not support the routine baseline screening for CARV in lung transplant donor-recipient pairs. (Figure presented.).