Long-Term Pulmonary Infections in Heart Transplant Recipients

Abstract

Objectives: Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients. Materials and Methods:Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected. Results: In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis. Conclusions: Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.

Bacterial-Host Interactions: Physiology and Pathophysiology of Respiratory Infection

“…Immunodeficient, immunosuppressed, or individuals with chronic morbidities that place them at risk for infection may take continuous prophylactic antimicrobials to prevent acquisition of potential pathogenic bacteria or fungi (62,212,291). For example, children with sickle cell disease are often on prophylactic penicillin treatment for the first 5 years of life to prevent invasive bacterial infections, such as that caused by the pneumococcus (53,166).…”

Indications for and outcomes of therapeutic plasma exchange after cardiac transplantation: A single center retrospective study

“…The only variable we found to be independently associated with overall survival was 30‐day post‐transplant infection (Table ). Other studies have similarly shown that infection increases post‐transplant morbidity and mortality . Infection may also increase predisposition toward AMR .…”

“…Other studies have similarly shown that infection increases post-transplant morbidity and mortality. 27,28 Infection may also increase predisposition toward AMR. 29,30 Interestingly, infection rates were similar across groups, suggesting that the use of TPE did not confer additive infectious risk.…”

Nanoparticle-Based Modulation and Monitoring of Antigen-Presenting Cells in Organ Transplantation

“…Outstanding short-term outcomes in organ transplantation have been achieved by pharmacologic immunosuppression. Despite these accomplishments, the detrimental effects’ life-long continuous immunosuppression compromise long-term allograft survival ( 1 , 2 ). Immunosuppressive combination therapies are not specific and often toxic, resulting in the deterioration of the patient quality of life and severe side effects, including infections and malignancies ( 3 , 4 ).…”