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The Impact of Allograft CXCL9 During Respiratory Infection on the Risk of Chronic Lung Allograft Dysfunction

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The Impact of Allograft CXCL9 During Respiratory Infection on the Risk of Chronic Lung Allograft Dysfunction

Michael Y Shino et al. OBM Transplant.

Abstract

Background: The long term clinical significance of respiratory infections after lung transplantation remains uncertain.

Methods: In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between respiratory infection and chronic lung allograft dysfunction (CLAD). We furthermore hypothesized that bronchoalveolar lavage fluid (BALF) CXCL9 concentrations are augmented during respiratory infections, and that episodes of infection with elevated BALF CXCL9 are associated with greater CLAD risk.

Results: In univariable and multivariable models adjusted for other histopathologic injury patterns, respiratory infection, regardless of the causative organism, was a strong predictor of CLAD development (adjusted HR 1.8 95% CI 1.3-2.6). Elevated BALF CXCL9 concentrations during respiratory infections markedly increased CLAD risk in a dose-response manner. An episode of respiratory infection with CXCL9 concentrations greater than the 25th, 50th, and 75th percentile had adjusted HRs for CLAD of 1.8 (95% CI 1.1-2.8), 2.4 (95% CI 1.4-4.0) and 4.4 (95% CI 2.4-8.0), respectively.

Conclusions: Thus, we demonstrate that respiratory infections, regardless of the causative organism, are strong predictors of CLAD development. We furthermore demonstrate for the first time, the prognostic importance of BALF CXCL9 concentrations during respiratory infections on the risk of subsequent CLAD development.

Keywords: CXCL9; CXCR3; Lung transplantation; chronic lung allograft dysfunction; infection.

Conflict of interest statement

Competing Interests The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1
Definition of abbreviations: ALI = acute lung injury, OP = organizing pneumonia, LB = lymphocytic bronchiolitis, AR = acute rejection

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