Anellovirus Dynamics Are Associated with Primary Graft Dysfunction in Lung Transplantation

Background. Primary graft dysfunction (PGD) is the leading cause of early death in lung transplant. Anelloviruses are small circular DNA viruses that have been noted to be present at elevated levels in immunosuppressed patients. They have been associated with both short- and long-term outcomes in lung transplant, and we hypothesized that anellovirus dynamics might be associated with the development of PGD. Methods. We analyzed alphatorquevirus (ie, an anellovirus genus) levels in whole blood samples from 64 adult lung transplant recipients. Results. Patients with a relatively rapid rise in alphatorquevirus levels in the week following transplant were less likely to develop higher-grade PGD over the first 3 days following transplant (P = 0.031). Conclusions. This study is the first to establish an association between the development of PGD and a component of the blood virome. While it is not known whether anelloviruses directly affect outcomes in lung transplant, they may serve as a biomarker of immune status in lung transplant recipients.