Infection and Bronchiolitis Obliterans among Native American Lung Transplant Recipients

Background: Alaska Native and Native American populations (AN/NA) are prone to respiratory tract infections, due to genetic predisposition and environmental factors. Since community acquired respiratory tract infections are associated with higher rates of bronchiolitis obliterans syndrome (BOS), it was hypothesized that AN/NA lung transplant recipients may experience a higher rate of BOS. Methods: The UNOS database was searched from 1995-2005 to identify adult AN/NA patients undergoing lung transplantation in the U.S. Among 11,103 patients, 33 AN/NA (13M/20F) patients were identified for further analysis. Among this population rates of: i) initial hospital stay, ii) first year hospitalizations, iii) hospitalization for infection, iv) subsequent BOS in years 1-5, were compared. Statistical analysis was performed using the fisher exact test, and a p value of <0.05 was considered significant. Results: AN/NA recipients did not have a higher incidence of BOS in years 1-5 following lung transplantation. They did have a higher rate of first year complications, reflected by higher hospitalization rates. AN/NA patients had a higher rate of first year hospitalizations for nonCMV infection (p < 0.03). Conclusions: AN/NA patients despite being at risk for community acquired respiratory infections did not have a higher rate of transplantation BOS in subsequent years.