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

Background: 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.

Methods: 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.

Results: 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]).

Conclusions: 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.