Infections in Lung Allograft Recipients: Ganciclovir Era
Received 4 May 2007; received in revised form 17 December 2007; accepted 17 December 2007. published online 10 March 2008.
Background
Infections are common after lung transplantation. This report analyzes infections and associated pathogens identified in 202 lung transplant recipients.
Methods
Infections were tallied according to sites of infection and associated pathogen(s). Infection events were also categorized by post-operative Days 0 to 100, 101 to 365, and after 365, and normalized to 100 patient-days before and after bronchiolitis obliterans syndrome (BOS).
Results
From November 1990 to November 2005, 202 patients received 208 lung transplants. The follow-up was 702.4 patient-years. A total of 178 lung transplant patients developed 859 infections, with 944 pathogens identified. Infections were in the lung in 559 (65.1%), mucocutaneous (skin, wound, catheter-related, and oral) in 88 (10.2%), in the blood in 85 (9.8%), and in other sites (urine, bowel, eye, and peritoneum) in 127 (14.8%). Most lung pathogens were bacterial (83.6%), and 57.9% were Pseudomonas aeruginosa. Fungi comprised 10.6%, with Aspergillus spp the most common (67.1%) isolate. Cytomegalovirus pneumonitis was seen in 4.3% of respiratory infections. BOS was diagnosed in 87 patients (43.1% of the total). Of all infections seen in the BOS population, there were 0.42 episodes/100 patient-days and 0.70 episodes/100 patient-days before and after BOS, respectively (p = 0.5).
Conclusions
These data provide an updated infection profile in the ganciclovir era after lung transplantation. When compared with pre-ganciclovir times, post-transplant cytomegalovirus infection incidence has notably declined, with filamentous fungi emerging as prevalent pathogens in its place. Such findings are important for refining management of infections in order to offer more stringent treatment against aggressive pathogens.
aMulti-Organ Transplant Center, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
bDepartments of Medicine and Genetics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
cLung Transplantation Program, Ochsner Medical Center, New Orleans, Louisiana
dLung Transplantation Program, Stanford University School of Medicine, Stanford, California.
Reprint requests: Vincent Valentine, MD, FCCP, FACP, Multi-Organ Transplant Center, Department of Internal Medicine, University of Texas Medical Branch, 4.140 John McCullough Building, 301 University Boulevard, Galveston, TX 77555-0772. Telephone: 409-772-3115. Fax: 409-747-1901.
ABSTRACT