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 bron- chiolitis 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 non-CMV infection (p < 0.03). Conclusions: AN/NA patients despite being at risk for community acquired respiratory infections did not have a higher rate of trans- plantation BOS in subsequent years.