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Approach Towards Infectious Pulmonary Complications in Lung Transplant Recipients

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Infectious Complications in Transplant Recipients

Part of the book series: Perspectives on Critical Care Infectious Diseases ((CCID,volume 1))

Abstract

Although improvements in operative techniques, immunosuppression management and prophylactic and therapeutic treatment have led to a considerable decline in infectious complications in lung transplant patients, the rate of infection in these patients remains higher than in other transplant recipients. Infection most commonly involves the transplanted lung and, in single-lung transplantation, the native lung. This reflects the extreme susceptibility of these organs to bacterial and/or fungal colonization, as well as the ease with which virus reactivation can occur at these sites. The lung is, after all, the only live organ which after transplant remains directly exposed to the outside environment. Other predisposing factors include functional impairment relating to the operative technique, immunosuppression (induction, use of cytolytic agents), impaired nutritional status, subclinical infections in “marginal” donors, and the development of bronchiolitis obliterans.

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References

  1. Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol, Rev 1997;10:86–124.

    CAS  Google Scholar 

  2. Arcasoy SM, KotloffRM. Lung transplantation. N Engl J Med 1999;340:1081–1091.

    Article  PubMed  CAS  Google Scholar 

  3. Davis RD, Pasque MK. Pulmonary transplantation. Ann Surg 1995;221:14–28.

    Article  PubMed  Google Scholar 

  4. Dummer JS, Montero CG, Griffith BP, et al. Infections in heart-lung transplant recipients. Transplantation 1986;41:725–729.

    Article  PubMed  CAS  Google Scholar 

  5. Horvath J, Dummer S, Loyd J, et al. Infection in the transplanted and native lung after single lung transplantation. Chest 1993;104:681–685.

    Article  PubMed  CAS  Google Scholar 

  6. Kramer MR, Marshall SE, Starnes VA, et al. Infectious complications in heart-lung transplantation. Analysis of 200 episodes. Arch Intern Med 1993;153:2010–16.

    Article  PubMed  CAS  Google Scholar 

  7. Maurer JR, Tullis DE, Grossman RF, et al. Infectious complications following isolated lung trasplantation. Chest 1992;101:1056–1059.

    Article  PubMed  CAS  Google Scholar 

  8. Deusch E, End A, Grimm M, et al. Early bacterial infections in lung transplant recipients. Chest 1993;104:1412–1416.

    Article  PubMed  CAS  Google Scholar 

  9. Bando K, Paradis IL, Komatsu K, et al. Analysis of time-dependent risk for infection, rejection, and death after pulmonary transplantation. J Thorac Cardiovasc Surg 1995;109:49–59.

    Article  PubMed  CAS  Google Scholar 

  10. Chaparro C, Maurer JR, Chamberlain D, et al. Causes of death in lung transplant recipients. J Heart Lung Transplant 1994;13:758–7566.

    PubMed  CAS  Google Scholar 

  11. Steinbach S, Sun L, Jiang R, et al. Transmissibility ofPseudomonas cepaciainfection in clinic patients and lung-transplant recipients with cystic fibrosis. N Engl J Med 1994;331:981–7.

    Article  PubMed  CAS  Google Scholar 

  12. Siddiqui MT, Garrity ER, Husain AN. Bronchiolitis obliterans organizing pneumonia-like reactions: a nonspecific response or an atypical form of rejection or infection in lung allograft recipients?. Hum Pathol 1996:27:714–719.

    Article  PubMed  CAS  Google Scholar 

  13. Flume PA, Egan TM, Paradowski LJ, et al. Infectious complications of lung transplantation: Impact of cystic fibrosis. Am J Respir Crit Care Med 1994;149:1601–1607.

    Article  PubMed  CAS  Google Scholar 

  14. de Leval MR, Smyth R, Whitehead B, et al. Heart and lung transplantation for terminal cystic fibrosis. J Thorac Cardiovasc Surg 1991;101:633–642.

    PubMed  Google Scholar 

  15. Metras D, Viard L, Kleitmann B, et al. Lung infections in pediatric lung transplantation: experience in 49 cases. Eur J Cardiothorac Surg 1999;15:490–494

    Article  PubMed  CAS  Google Scholar 

  16. Nunley DR, Grgurich W, Iacono AT, et al. Allograft colonization and infections with pseudomonas in cystic fibrosis lung transplant recipients. Chest 1998;113:1235–1243.

    Article  PubMed  CAS  Google Scholar 

  17. Aris RM, Gilligan PH, Neuringer IP, et al. The effects of panresistant bacteria in cystic fibrosis patients on lung transplant outcome. Am J Respir Crit Care Med 1997;155:1699–1704.

    Article  PubMed  CAS  Google Scholar 

  18. Snell GI, de Hoyos A, Krajden M, et al.Pseudomona cepaciain lung transplant recipients with cystic fibrosis. Chest 1993;103:466–471.

    Article  PubMed  CAS  Google Scholar 

  19. Ramirez JC, Patterson GA, Winton T, et al. Bilateral lung transplantation for cystic fibrosis. J Thorac Cardiovasc Surg 1992;103:287–294.

    PubMed  CAS  Google Scholar 

  20. Low DE, Kaiser LR, Haydock DA, et al. The donor lung: infectious and pathologic factors affecting outcome in lung transplantation. J Thorac Cardiovasc Surg 1993;106:614–21.

    PubMed  CAS  Google Scholar 

  21. Jones SD, Fullerton DA, Zamora MR, et al. Transmission ofLactobacilluspneumonia by a transplanted lung. Ann Thorac Surg 1994;58:887–889.

    Article  PubMed  CAS  Google Scholar 

  22. Gass R, Fisher J, Badesch D, et al. Donor-to-host transmission ofMycoplasma hominisin lung allograft recipients. Clin Infect Dis 1996;22:567–568.

    Article  PubMed  CAS  Google Scholar 

  23. Prodinger WM, Bonatti H, Allerberger F, et al. Legionella pneumonia in transplant recipients: a cluster of cases of eight year’s duration. J Hosp Infect 1994;26:191–202.

    Article  PubMed  CAS  Google Scholar 

  24. Chan CC, Abi-Saleh WJ, Arroliga AC, et al. Diagnostic yield and therapeutic impact of flexible bronchoscopy in lung transplant recipients. J Heart Lung Transplant 1996;15:196–215.

    PubMed  CAS  Google Scholar 

  25. Baz MA, Layish DT, Govert JA, et al. Diagnostic yield of bronchoscopies after isolated lung transplantation. Chest 1996;110:84–88.

    Article  PubMed  CAS  Google Scholar 

  26. Dupuis RE, Sredzienski ES. Tobramycin pharmacokinetics in patients with cystic fibrosis preceding and following lung transplantation. Ther Drug Monit 1999;21:161–165.

    Article  PubMed  CAS  Google Scholar 

  27. Ross DJ, Marchevsky A, Kass RM. “Nonspecific Chronic Inflammation” in lung allografts: association with respiratory pathogens. Transplant Proc 1996;28:2983–2986.

    PubMed  CAS  Google Scholar 

  28. Ettinger NA, Bailey TC, Trulock EP, et al.Cytomegalovirus infection and pneumonitis: impact after isolated lung transplantation. Am Rev Respir Dis 1993;147:1017–1023.

    Article  PubMed  CAS  Google Scholar 

  29. Paradis IL, William P. Infection after lung transplantation. Semin Respir Infect 1993;8:207–215.

    PubMed  CAS  Google Scholar 

  30. Duncan Ai, Dummer IS Paradis IL, et al. Cytomegalovirus infection and survival in pulmonary transplant recipients. J Heart Lung Transplant 1991; 23:638–646.

    Google Scholar 

  31. Maurer J, Tullis E, Scavuzzo M, et al. Cytomegalovirus infection in isolated lung transplant recipients. J Heart Lung Transplant 1991;10:647–649.

    PubMed  CAS  Google Scholar 

  32. Smyth RL, Scott JP, Borysiewicz LK, et al. Cytomegalovirus infection in heart-lung transplant recipients. Risk factors, clinical associations, and response to treatment. J Infect Dis 1991;164:1045–1050.

    Article  PubMed  CAS  Google Scholar 

  33. Gould FK, Freeman R, Taylor CE, et al. Prophylaxis and management of cytomegalovirus pneumonitis after lung transplantation: A review of the experience of one center. J Heart Lung Transplant 1993;12:695–699.

    PubMed  CAS  Google Scholar 

  34. Calhoon JH, Nichols L, Davis R, et al. Single lung transplantation. Risk factors in postoperative cytomegalovirus infection. J Thorac Cardiovasc Surg 1992;103:21–26.

    PubMed  CAS  Google Scholar 

  35. Paradis IL, Grgurich WF, Dummer JS, et al. Rapid detection of cytomegalovirus pneumonia from lung lavage cells. Am Rev Resp Dis 1988;138;697–702.

    Article  PubMed  CAS  Google Scholar 

  36. Gavalda J, Roman A, Pahissa A. Infeccion por citomegalovirus en el trasplante de pulmon. In: J Torre-Cisneros (ed.). Infeccion por citomegalovirus en el paciente trasplantado. JR Prous, Barcelona 1996:123–139.

    Google Scholar 

  37. Solans EP, Yong S, Husain AN, et al. Bronchioloalveolar lavage in the diagnosis of CMV pneumonitis. Diagn Cytopathol 1997;16:350–352.

    Article  PubMed  CAS  Google Scholar 

  38. Storch GA, Ettinger NA, Ockner MW, et al. Quantitative cultures of the cell fraction and supernatant of bronchoalveolar lavage fluid for the diagnosis of cytomegalovirus pneumonitis in lung transplant recipients. J Infect Dis 1993 168:1502–1506.

    Article  PubMed  CAS  Google Scholar 

  39. Duncan SR, Paradis IL, Similo S, et al. Sequelae of cytomegalovirus pulmonary infections in lung allograft recipients. Am Rev respir Dis 1992;146:1419–1425.

    Article  PubMed  CAS  Google Scholar 

  40. Mackowiak PA, Goggans M, Torre W, et al. Relationship between cytomegalovirus and colonization of the oropharynx by gram negative bacilli following renal transplantation. Epidemiol Infec 1991;107:411–240

    Article  CAS  Google Scholar 

  41. Milne DS, Gascoigne A, Wilkes J, et al. The immunohistopathology of obliterative bronchiolitis following lung transplantation. Transplantation 1992;54:748–750.

    Article  PubMed  CAS  Google Scholar 

  42. Scott JP, Higenbottam TW, Sharples L et al. Risk factors for obliterative brochiolitis in heart-lung transplant recipients. Transplantation 1991;51:813–817.

    Article  PubMed  CAS  Google Scholar 

  43. Keenan RJ, Lega ME, Dummes JS et al. Cytomegalovirus serologic status and postoperative infection correlated with risk of develop** chronic rejection after pulmonary transplantation. Transplantation 1991;51:433–438.

    Article  PubMed  CAS  Google Scholar 

  44. Duncan SR, Grgurich WF, Iacono AT, et al. A comparison of ganciclovir and acyclovir to prevent cytomegalovirus after lung transplantation. Am J Respir Crit Care Med 1994;150:146–152.

    Article  PubMed  CAS  Google Scholar 

  45. Soghikian MV, Valentine VG, Berry GJ, et al. Impact of ganciclovir prophylaxis on heart-lung and lung transplant recipients. J Heart Lung Transplant 1996;15:881–887.

    PubMed  CAS  Google Scholar 

  46. Gutierrez CA, Chaparro C, Krajden M, et al. Cytomegalovirus viremia in lung transplant recipients receiving ganciclovir and immune globulin. Chest 1998;113:924–932.

    Article  PubMed  CAS  Google Scholar 

  47. Halme M, Lautenschlager I, Halme L, et al. Ganciclovir prophylaxis after lung and heart-lung transplantation. Transplant Int 1998;11 (suppl 1P):S499–S501.

    Google Scholar 

  48. Bailey TC, Trulock EP, Eltinger NA, et al. Failure of prophylactic ganciclovir to prevent cytomegalovirus disease in recipients of lung transplant. J Infect Dis 1992;165:548–552.

    Article  PubMed  CAS  Google Scholar 

  49. Kelr JL, Albert RK, Wood DE, et al. Efficacy of a 6-week prophylactic ganciclovir regimen and the role of serial cytomegalovirus antibody testing in lung transplant recipients. Transplantation 1995:59:1144–1147.

    Google Scholar 

  50. Speich R, Thumheer R, Gaspert A, et al. Efficacy and cost effectiveness of oral ganciclovir in the prevention of cytomegalovirus disease after lung transplantation. Transplantation 1999;67:315–320.

    Article  PubMed  CAS  Google Scholar 

  51. Wreghitt TG, Abel SJ, McNeil K, et al. Intravenous ganciclovir prophylaxis for cytomegalovirus in heart, heart lung, and lung transplant recipients. Transplant Int 1999;12:254–260.

    Article  CAS  Google Scholar 

  52. Zamora MR, Fullerton DA, Campbell DN, et al. Use of cytomegalovirus hyperimmune globulin for prevention of CMV disease in CMV-seropositive lung transplant recipients. Transplant Proc 1994;26 (suppl 1):49–51.

    PubMed  CAS  Google Scholar 

  53. Falagas ME, Snydman DR, Recurrent cytomegalovirus disease in solid-organ transplant recipients. Transplant Proc 1995;5 (suppl 1):34–37.

    Google Scholar 

  54. Palmer SM, Heenshaw NG, Howell DN, et al. Community respiratory viral infection in adult lung transplant recipients. Chest 1998;113:944–950.

    Article  PubMed  Google Scholar 

  55. Krinzman S, Basgoz N, Kradin R, et al. Respiratory syncytial virus-associated infections in adult recipients of solid organ transplants. J Heart Lung Transplant 1998;17:202–210.

    PubMed  CAS  Google Scholar 

  56. Holt ND, Gould FK, Taylor CE, et al. Incidence and significance of noncytomegalovirus viral respiratory infection after adult lung transplantation. J Heart Lung Transplant 1997;16:416–419.

    PubMed  CAS  Google Scholar 

  57. Wendt CH, Fox JM, Hertz MI. Paramyxovirus infection in lung transplant recipients. J Heart Lung Transplant 1995;14:479–485.

    PubMed  CAS  Google Scholar 

  58. Ohori NP, Michaels MG, Jaffe R, et al. Adenovirus pneumonia in lung trasnplant recipients. Hum Pathol 1995;26:1073–1079.

    Article  PubMed  CAS  Google Scholar 

  59. Paya CV. Fungal infections in solid-organ transplantation. Clin Infect Dis 1993;16:677–88.

    Article  PubMed  CAS  Google Scholar 

  60. Kanj SS, Welty-Wolf K, Madden J, et al. Fungal infections in lung and heart-lung transplant recipients. Report of 9 cases and review of the literature. Medicine 1996;75:142–56.

    Article  PubMed  CAS  Google Scholar 

  61. Bertocchi M, Bastien TO, Rabodoniria M, et al. Fungal infections in lung transplant recipients. Transplant Proc 1995;27:1695.

    PubMed  CAS  Google Scholar 

  62. Brooks RG, Hofflin JM, Jamieson SW, et al. Infectious complications in heart-lung transplant recipients. Am J Med 1985;79:412–422.

    Article  PubMed  CAS  Google Scholar 

  63. Dauber JH, Paradis IL, Dummer JS. Infectious complications in pulmonary allograft recipients. Clin Chest Med 1990;11:291–308.

    PubMed  CAS  Google Scholar 

  64. Kramer MR, Denning DW, Marshall SE, et al. Ulcerative tracheobronchitis after lung transplantation: a new form of invasive aspergillosis. Am Rev Respir Dis 1991;144:552–6.

    Article  PubMed  CAS  Google Scholar 

  65. Hibberd PL, Rubin RH. Clinical aspects of fungal infection in organ transplant recipients. Clin Infect Dis 1994;19(Suppl 1):S33–40.

    Article  PubMed  Google Scholar 

  66. Palmer SM, Perfect JR, Howell DN, et al. Candidal anastomotic infection in lung transplant recipients. J Heart Lung Transplant 1998;17:1029–33.

    PubMed  CAS  Google Scholar 

  67. Mc Dougall JC, Vigneswaran WT, Peters SG, et al. Fungal Infection of the contralateral native lung after single-lung transplantation. Ann Thorac Surg 1993;56:176–178.

    Article  CAS  Google Scholar 

  68. Griffith BP, Bando K, Hardesty RL, et al. A prospective ramdomized trial of FK506 versu cyclosporine after human pulmonary transplantation. Transplantation 1994:57:848–851.

    Article  PubMed  CAS  Google Scholar 

  69. Keenan RJ, Konishi H, Kawai A, et al. Clinical trial of tacrolimus versus cyclosporine in lung transplantation. Ann Thorac Surg 1995;60:580–585.

    Article  PubMed  CAS  Google Scholar 

  70. Clarke A, Skelton J, Fraser RS. Fungal tracheobronchitis. Report of 9 cases and review of the literature. Medicine 1991;70:1–14.

    Article  PubMed  CAS  Google Scholar 

  71. Cahill BC, Savik, SK, Jun BJ, et al. Aspergillus airway colonization and invasive disease after lung transplant [abstract]. Am J Respir Crit Care Med 1995;151:A460.

    Google Scholar 

  72. Westney GE, Kesten S, De Hoyos A, et al.Aspergillusinfection in single and double lung transplant recipients. Transplantation 1996;61:915–919.

    Article  PubMed  CAS  Google Scholar 

  73. Yeldandi V, Laghi F, McCabe MA, et al. Aspergillus and lung tmaplantation. J Heart Lung Transpl 1995;14:883–890.

    CAS  Google Scholar 

  74. Kusne S, Torre-Cisneros J, Matiez R et al. Factors associated with invasive lung aspergillosis and the significance of positive aspergillus culture after liver transplantation. J Infect Dis 1992;166:1379–1383.

    Article  CAS  Google Scholar 

  75. Torre-Cisneros J, Lopez OL, Kusne S, et al. CNS aspergillosis in organ transplantation: a clinicopathological study. J Neurol Neurosurg Psychiatry 1993;56:188–193.

    Article  PubMed  CAS  Google Scholar 

  76. Tornee FJC, Mannes GPM, Van der Werf, et al. Serodiagnosis and monitoring of Aspergillus infections after lung transplantation. Ann Intern Med 1996:125:197–201.

    Article  Google Scholar 

  77. Rabodoniria M, Paulus S, Thevenet F, et al. Disseminated Scedosporium prolificans (S. inflatum) infection after single-lung transplantation. Clin Infect Dis 1994;19:138–142.

    Article  Google Scholar 

  78. Denning DW. Therapeutic outcome in invasive aspergillosis. Clin Infect Dis 1996;23:608–615.

    Article  PubMed  CAS  Google Scholar 

  79. Muñoz P, Torre-Cisneros J, Bouza E, et al. Invasive aspergillosis in transplant recipients. A large multicentric study. 36th ICAAC. American Society for Microbiology 1996;242:J128.

    Google Scholar 

  80. Sugar AM, Saunders C,Idelson BA, et al. Interaction of fluconazole and cyclospirine. Ann Intern Med 1989;110:844.

    Article  PubMed  CAS  Google Scholar 

  81. Gavalda J, Roman A, Bravo C, et al. Efficacy of nebulized amphotericin B for prevention of aspergillus infection in lung transplantation. 37th ICAAC. American Society for Microbiology 1997;374:LM-54.

    Google Scholar 

  82. Levine MS, Shviner RB, Waters PF, et al. Analysis of antifungal prophylaxis in lung transplantation [abstract]. Am J Resp Crit Care Med 1995;151:A460.

    Google Scholar 

  83. Calvo V, Borro JM, Morales P, et al. Antifungal prophylaxis during the early postoperative period of lung transplantation. Valencia Lung Transplant Group. Chest 1997;115:1301–1304.

    Google Scholar 

  84. Schulman LL, Scully B, McGregor CC, et al. Pulmonary tuberculosis after lung transplantation. Chest 1997;111:1459–1462.

    Article  PubMed  CAS  Google Scholar 

  85. Aguado JM, Herrero JA, Gavalda J, et al. Clinical presentation and outcome of tuberculosis in kidney, liver and heart transplant recipients in Spain. Transplantation 1997;63:1278–1286.

    Article  PubMed  CAS  Google Scholar 

  86. Torre-Cisneros J, de la Mata M, Pozo JC, et al. Randomized trial of weekly sulfadoxine/pyrimethamine vs. daily low-dose trimethoprim-sulfamethoxazole for the prophylaxis of Pneumocystis carinii pneumonia after liver transplantation. Clin Infect Dis 1999;29:771–774.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Infectious Diseases Section, Reina Sofia University Hospital, 14004-Córdoba, Spain

    Julián de la Torre-Cisneros

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  1. Julián de la Torre-Cisneros
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Editors and Affiliations

  1. Infectious Diseases Section, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA

    Nina Singh M.D.

  2. Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Nina Singh M.D.

  3. Infectious Diseases Unit, Department of Microbiology, Hospital “12 de Octubre”, Av de Andalucia km 5,400, Madrid, E-28041, Spain

    José M. Aguado M.D.

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de la Torre-Cisneros, J. (2001). Approach Towards Infectious Pulmonary Complications in Lung Transplant Recipients. In: Singh, N., Aguado, J.M. (eds) Infectious Complications in Transplant Recipients. Perspectives on Critical Care Infectious Diseases, vol 1. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1403-9_10

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  • DOI: https://doi.org/10.1007/978-1-4615-1403-9_10

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