Coming in from the cold

Lung transplantation represents the last hope for many patients with end-stage lung disease, but given the scarcity of organs and the worse results of re-do transplantation, the transplanted lung must be protected from damage as carefully as the reputations of our egregious politicians. Respiratory viruses are already causally implicated in the lung attacks which cause so much long term damage in asthma, COPD, cystic fibrosis (CF) and other diseases. In this issue, Bridevaux et al (Editors’ choice; see page 32) report a long-term prospective study of the prevalence of common respiratory viruses in lung transplant recipients. They found that viruses were common, almost invariably associated with symptoms, but they could not show any association with rejection. In an accompanying editorial, Glanville (see page 1) speculates that the picture may not be quite as reassuring as the properly cautious interpretation in the manuscript. Viruses cause epithelial damage and aberrant repair of recurrent insults is thought to prime the airway for downstream rejection. One could also add that viral …