Infections after Lung Transplantation

Abstract

Despite advances in prophylaxis and therapy, infections remain a major source of morbidity and mortality after lung transplantation. Lung transplant recipients are at increased risk for both community-acquired and nosocomial pathogens, which may develop at various time points. The risk of infections increases with the intensity of immunosuppression. Careful assessment of the recipient is essential to assure adequate prophylactic or preemptive therapy. Aggressive prophylaxis for some infections (e.g., cytomegalovirus) has substantially reduced the prevalence of serious infections due to this organism. Tuberculin-positive individuals should be treated with prophylactic isoniazid to reduce the chance for reactivation of tuberculosis following transplantation. Myriad opportunistic pathogens (including various viruses, bacteria, fungi, etc.) may complicate transplantation, owing to the effects of multiagent immunosuppressive therapy. This review addresses the salient pathogens that may infect organ transplant recipients, and discusses strategies to prevent or treat specific pathogens in this highly susceptible patient population.

Detection of Epstein–Barr virus DNA in peripheral blood is associated with the development of bronchiolitis obliterans syndrome after lung transplantation

“…Most CMV reactivations occur 1 to 6 months after transplantation. 6,27 Only 63 LTR (16.4%) of the present study population were in this time frame. The remaining LTR had a low risk of CMV reactivation.…”

“…[2][3][4] After lung transplantation, virus infections or reactivations with herpesviruses or human adenovirus (HAdV) occur. [5][6][7][8] CMV causes CMV syndrome or tissue-invasive disease and has been associated with graft rejection in LTR. 7,8 Epstein-Barr virus (EBV) is associated with the development of posttransplant lymphoproliferative disease (PTLD) and virus load monitoring in blood can identify patients at risk.…”

Outcome of lung transplant recipients requiring readmission to the intensive care unit

“…Infectious complications account for 19.5% of deaths at 3 to 5 years after lung transplantation 16 and may be related to the constant exposure of the transplanted lung to the environment, both nosocomial and community, as well as reactivation from within the recipient. 17 The risk of infection is determined primarily by 2 factors: the intensity of exposure to potential pathogens and the net state of immunosuppression. 18 In view of the high mortality related to sepsis, it is important to identify interventions that may modify or limit its severity and consequences.…”

“…This may be partly explained by the fact that chronic rejection is common 21 and accounts for 28.5% of deaths at 3 to 5 years after transplantation. 17 Because there is a link between acute cellular (ACR) and chronic rejection, immunosuppression is frequently augmented for refractory cases of ACR and emerging chronic rejection. However, immunosuppression may amplify the effects of infection, increasing the risk of tissue invasion, dissemination, and superinfection.…”

Opportunistic Infections--Coming to the Limits of Immunosuppression?

“…For example, recurrent HCV infection may increase the risk for liver graft rejection. Pneumonia, including aspiration, community-acquired respiratory viruses, CMV, and bacterial infections, will increase the rate of obliterative bronchiolitis in lung recipients (Bando et al 1995;Kroshus et al 1997;Avery 2006). CMV also contributes to cardiac and renal allograft rejection (Lowance et al 1999;Potena and Valantine 2007).…”