*Purpose: The detection of de novo donor-specific anti-HLA antibodies (DSA) post lung transplant have been associated with significantly increased risk for antibody-mediated rejection (AMR) and lung allograft dysfunction. Community acquired respiratory virus infections (CARV) in lung transplant recipients are associated with increased incidence of allograft dysfunction and rejection. However, the effect of CARV on the development of de novo DSA post lung transplant is not well defined.

*Methods: We assessed the relationship between CARV and the development of de novo DSA post lung transplant in a cohort of consecutive lung transplant recipients (n = 67) that were followed for up to 24 months post-transplant. Bronchoalveolar lavage specimens were collected during 2017-2018 and retrospectively tested using a commercially-available respiratory multiplex molecular panel (Verigene RP Flex Test). One Lambda LABScreen kit was used to detect anti-HLA antibodies in serum samples. Donor specific antibodies were defined as having a Mean Fluorescence Intensity (MFI) of more than 1000.

*Results: Forty three of 67 (64.1%) recipients had no DSA on the day of transplant. CARV was diagnosed within the first 3 months post-transplant in 11/43 (25.5%) recipients with no DSA (Rhinovirus = 3; Adenovirus = 4; Parainfluenza = 2; RSV = 1; Influenza = 1). De novo DSA were detected in 6/11 (54.5%) compared to 13/32 (40.6%) CARV positive and negative recipients respectively. In addition, the median time it took to develop de novo DSA post-transplant was 1 month in the CARV positive compared to 2 months in the CARV negative recipients. The prevalence of HLA class I and II DSA in recipients with and without history of CARV is shown in table below

*Conclusions: A minority of the lung transplant recipients in our study were CARV positive. In addition, de novo DSA appeared to be more prevalent and were detected earlier in CARV positive recipients. These findings along with the possible synergistic negative impact of CARV and de novo DSA on lung transplant outcomes should be further explored in a larger study.

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