Pneumonia After Lung Transplantation in the Resitra Cohort: A Multicenter Prospective Study

Abstract

The aim of the present study is to evaluate the epidemiology, etiology and prognosis of pneumonia in lung transplant (LT) recipients. This is a prospective, multicenter study of a consecutive cohort of LT recipients in Spain. From September 2003 to November 2005, 85 episodes of pneumonia in 236 LT recipients were included (incidence 72 episodes per 100 LT/year). Bacterial pneumonia (82.7%) was more frequent than fungal (14%) and viral pneumonia (10.4%). The most frequent microorganisms in each etiological group were Pseudomonas aeruginosa (n = 14, 24.6%), CMV (n = 6, 10.4%) and Aspergillus spp. (n = 5, 8.8%). Incidence of Aspergillus spp. and CMV pneumonia is lower than previously reported, probably due to the spread of universal prophylaxis. Pneumonia caused by viruses appeared significantly later than pneumonia due to gram-negative bacilli, fungi and those without known etiology (p < 0.01, p = 0.03 and p = 0.02, respectively). The routine use of ganciclovir has changed the natural history of CMV infection, so that pneumonia appears later, once prophylaxis is suspended. The probability of survival during the first year of follow-up was significantly higher in the multivariate analysis in LT recipients who did not have a pneumonia episode compared with those that had at least one episode (p < 0.01).

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

“…Pseudomonas aeruginosa infection is particularly relevant in the setting of lung transplantation because P aeruginosa pneumonia is correlated with inferior patient survival in this population (164). The role of lung allograft colonization by P aeruginosa as a risk factor for the development of BOS has not been fully determined (11,165).…”

Complications of Post-Transplant Immunosuppression

“…Most common isolates are S. aureus, but also enteric gram negative bacteria in abdominal organ recipients. The incidence of pneumonia also varies between organs from 7.3% within the first year after kidney transplant [29] to 22% after liver transplant [30] to 36% in lung transplant recipients [31] and is associated with prolonged intensive care stay and hospital stay. The source of bacterial bloodstream infections after transplant, in addition to intravenous catheters, include the respiratory tract, the urinary tract and the abdomen.…”

Lung Transplantation: Advances and Roadblocks in Treatment

“…(Kramer et al 1993) This opportunistic infection has a higher incidence in CF patients and has been estimated to be responsible for up to 33% of pneumonias in all transplant recipients. (Aguilar-Guisado et al 2007;Campos et al 2008) P. aeruginosa airway infection prior to transplant does not appear to demonstrate a predictive relationship for chronic rejection. However, this is not the case for colonization in the post-operative period.…”