• Viral infection
• Respiratory Infection
• Lung Transplantation
• Bronchoscopy

Community-acquired respiratory viruses (CARV) represent an ever present risk to the lung transplant (LTX) recipient.1 Alone among solid organ transplants, the lung allograft is exposed to the ambient environment with every breath; hence, it is exposed to CARV, which may trigger rejection.2 Or at least we once thought despite some recent evidence to the contrary.3–5 The current article in the journal expands the previous work of the same group and provides a comprehensive analysis of 112 patients examined on 903 occasions over a 3-year period with a further 2-year follow-up to determine the presence and effects of CARV.6–8 The results are compelling in the main. CARV account for about 30% of all acute respiratory presentations after LTX and are a dominant cause of new respiratory symptoms with a risk of hospitalisation of 17–50% depending on type. Surprisingly, 10% of asymptomatic LTX recipients had a positive test for CARV at screening visits (predominantly rhinovirus), but whether their asymptomatic status represents the effects of maintenance immune suppressive therapy on the inflammatory response cannot be ascertained from the study.

The major strength of this prospective study is the exhaustive assessment of both symptomatic …