Infections Within the First Month After Pediatric Lung Transplantation: Epidemiology and Impact on Outcomes

Abstract

Background Despite successes in lung transplantation, with infection as the leading cause of death in the first year following lung transplantation, there remains a lag in survival compared with other solid organ transplants. Infections that occur early after transplantation may impact short- and long-term outcomes in pediatric lung transplant recipients (LTRs). Methods We performed a retrospective review of pediatric LTRs at a large quaternary-care hospital from January 2009 to March 2016 to evaluate both epidemiologic features of infection in the first 30 days post-transplantation and mortality outcomes. The 30 days were divided into early (0–7 days) and late (8–30 days) periods. Results Among the 98 LTRs, there were 51 episodes of infections. Cystic fibrosis (CF) was associated with early bacterial infections (P = .004) while non-CF was associated with late viral (P = .02) infections. Infection after transplantation was associated with worse survival by Kaplan-Meier analysis (P value log rank test = .007). Viral infection in the late period was significantly associated with 3-year mortality after multivariable analysis (P = .02). Conclusions Infections in pediatric LTRs were frequent in the first 30 days after transplant, despite perioperative antimicrobial coverage. The association of 3-year mortality with late viral infections suggests a possible important role in post-transplant lung physiology and graft function. Understanding the epidemiology of early post-lung transplant infections can help guide post-operative management and interventions to reduce their incidence and the early- and long-term impact in this population.

Donor blood cultures and outcomes after lung transplantation: a single‐center report

“…Three cases of posttransplant P. aeruginosa bacteremia seemingly originated from the recipients themselves. Studies have reported a propensity for patients with cystic fibrosis to develop posttransplant bacteremia, including increased occurrences of P. aeruginosa and Burkholderia spp. bacteremia in these patients 29–33 . Our study demonstrates that respiratory pathogens cultured from patients with suppurative lung diseases may lead to invasive infections after transplant.…”

“…bacteremia in these patients. [29][30][31][32][33] Our study demonstrates that respiratory pathogens cultured from patients with suppurative lung diseases may lead to invasive infections after transplant. S. aureus is the most common cause of bacteremia after lung transplantation and more frequently occurs in patients who are colonized before surgery.…”