We thank Preiksaitis and Limaye for their comments on our paper1 and their interest and we attempt to provide herewith responses to their questions. First, they correctly note that we did not find an association between viral infection and acute rejection in our lung transplant recipient (LTR) cohort.2 However, this finding does not preclude a possible association between viral infection and bronchiolitis obliterans syndrome (BOS). While the temporal association between viral infection and acute rejection is expected to be short, the BOS inflammatory process and lung function decline may develop months after infection. In our study, follow-up was too short in many LTRs at this stage to allow for an adequate analysis of factors associated with incident BOS. Analyses pertaining to such are currently ongoing.

We agree with Preiksaitis and Limaye that respiratory viral infections have been under-recognised thus far. They raise the criticism that surveillance testing …