ArticleThe Lancet. Respiratory medicine2021
Lung microbiota predict chronic rejection in healthy lung transplant recipients: a prospective cohort study.
Article in The Lancet. Respiratory medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers.
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Who cites it
49 citing papers in PubMed, 92 citations in OpenAlex.
- The role of the respiratory microbiome in acute and chronic respiratory diseases.Nature reviews. Microbiology · 2026Review
- Bronchoalveolar lavage for supporting acute cellular rejection in lung transplant recipients: A retrospective analysis.JHLT open · 2026Article
- Pneumonia in lung transplant recipients: the role of donor, recipient, and hospital-acquired microorganisms.Respiratory research & clinical practice · 2026Article
- Crosstalk between the microbiome and the mucosal immunoglobulin A system in the lung, in health and disease.Frontiers in cellular and infection microbiology · 2026Review
- Enrichment of the commensal microbiome in the lower respiratory tract is associated with improved outcomes following lung transplantation.Chinese medical journal pulmonary and critical care medicine · 2025Article
- The Respiratory Tract Microbiome and Human Health.Microbial biotechnology · 2025Review
- Lung allograft dysbiosis associates with immune response and primary graft dysfunction.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2025Article
- One lung ventilation during thoracoscopic lobectomy alters lung microbiome miversity and composition.Scientific reports · 2025Article
- The fungal microbiota modulate neonatal oxygen-induced lung injury.Microbiome · 2025Article
- Regulatory T cell therapy in lung transplantation: bridging the gap from bench to bedside.Frontiers in immunology · 2025Review
- High-dimensional flow cytometry reveals lymphocyte subset populations predictive of chronic lung allograft dysfunction.Clinical & translational immunology · 2025Article
- Microbiome and metabolome patterns after lung transplantation reflect underlying disease and chronic lung allograft dysfunction.Microbiome · 2024Article
- Beyond the organ: lung microbiome shapes transplant indications and outcomes.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2024Review
- The gut-airway microbiome axis in health and respiratory diseases.Nature reviews. Microbiology · 2024Review
- Longitudinal Lower Airway Microbial Signatures of Acute Cellular Rejection in Lung Transplantation.American journal of respiratory and critical care medicine · 2024Article
- Lung Transplant Outcomes Keep BUGging us: Acute Cellular Rejection and the Lung Microbiome.American journal of respiratory and critical care medicine · 2024Article
- Comparison of the upper and lower airway microbiome in early postoperative lung transplant recipients.Microbiology spectrum · 2024Article
- Definitions of Dysbiosis in Chronic Lung Allograft Dysfunction and High Bacterial Biomass.American journal of respiratory and critical care medicine · 2024Article
- The Lung Microbiome Predicts Mortality and Response to Azithromycin in Lung Transplant Recipients with Chronic Rejection.American journal of respiratory and critical care medicine · 2024Article
- Mitochondrial DNA in bronchoalveolar lavage fluid is associated with the prognosis of idiopathic pulmonary fibrosis: a single cohort study.Respiratory research · 2024Article
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundAlterations in the respiratory microbiome are common in chronic lung diseases, correlate with decreased lung function, and have been associated with disease progression. The clinical significance of changes in the respiratory microbiome after lung transplant, specifically those related to development of chronic lung allograft dysfunction (CLAD), are unknown. The aim of this study was to evaluate the effect of lung microbiome characteristics in healthy lung transplant recipients on subsequent CLAD-free survival.
methodsWe prospectively studied a cohort of lung transplant recipients at the University of Michigan (Ann Arbor, MI, USA). We analysed characteristics of the respiratory microbiome in acellular bronchoalveolar lavage fluid (BALF) collected from asymptomatic patients during per-protocol surveillance bronchoscopy 1 year after lung transplantation. For our primary endpoint, we evaluated a composite of development of CLAD or death at 500 days after the 1-year surveillance bronchoscopy. Our primary microbiome predictor variables were bacterial DNA burden (total 16S rRNA gene copies per mL of BALF, quantified via droplet digital PCR) and bacterial community composition (determined by bacterial 16S rRNA gene sequencing). Patients' lung function was followed serially at least every 3 months by spirometry, and CLAD was diagnosed according to International Society of Heart and Lung Transplant 2019 guidelines.
findingsWe analysed BALF from 134 patients, collected during 1-year post-transplant surveillance bronchoscopy between Oct 21, 2005, and Aug 25, 2017. Within 500 days of follow-up from the time of BALF sampling, 24 (18%) patients developed CLAD, five (4%) died before confirmed development of CLAD, and 105 (78%) patients remained CLAD-free with complete follow-up. Lung bacterial burden was predictive of CLAD development or death within 500 days of the surveillance bronchoscopy, after controlling for demographic and clinical factors, including immunosuppression and bacterial culture results, in a multivariable survival model. This relationship was evident when burden was analysed as a continuous variable (per log
interpretationAmong asymptomatic lung transplant recipients at 1-year post-transplant, increased lung bacterial burden is predictive of chronic rejection and death. The lung microbiome represents an understudied and potentially modifiable risk factor for lung allograft dysfunction.
fundingUS National Institutes of Health, Cystic Fibrosis Foundation, Brian and Mary Campbell and Elizabeth Campbell Carr research gift fund.
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