Chest
Volume 101, Issue 4, April 1992, Pages 1056-1059
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Clinical Investigations
Infectious Complications following Isolated Lung Transplantation

https://doi.org/10.1378/chest.101.4.1056Get rights and content

Study Objective

To ascertain the incidence, types, morbidity, and mortality of infectious episodes in isolated lung transplant recipients.

Design

Retrospective chart review of patients who have undergone transplants over a six-year period in one institution.

Patients

Twenty-three single and 17 double lung transplants followed up between 2 and 68 months.

Results

Fifty-one episodes of infection occurred in the group with a slight predominance in the double lung transplants. The 32 episodes of bacterial infection constituted the largest group of infection and more than half of these were pneumonias. Organisms identified were predominantly Gram negative. While bacterial processes made up the bulk of infections, fatalities were rare. Viral and fungal infections were less common, but more often fatal. Of six cases of viral pneumonitis, two were fatal; two of five cases of invasive fungal infection were also fatal. Overall, six patients died of infection.

Conclusion

Our findings support previous reports from heart-lung centers documenting a high rate of infectious complications, particularly pneumonia, in recipients of lung grafts. In our experience, bacterial infections are the most common (two of three infections), but have the lowest mortality. Efforts should be directed toward establishing effective prophylaxis programs and early detection of infection.

Section snippets

Patients

Infectious episodes were reviewed retrospectively in 40 patients receiving single or double lung transplants at the University of Toronto between November 1983 and May 1989. Twenty-three single and 17 double lung transplants are included in this analysis. The indication for single lung transplant was pulmonary fibrosis in 19, emphysema in 3, and Eisenmenger's syndrome in 1. The indication for double lung transplant was emphysema in eight, bronchiectasis in four, cystic fibrosis in two,

RESULTS

Fifty-one infectious episodes were documented in 26 of the 40 patients (Table 1). Fourteen patients (35 percent) had no infectious complications. The infections were slightly more common in double lung recipients (76 percent of patients) than single lung recipients (56 percent of patients). The majority of infections involved the lung (35/51).

There were 32 documented episodes of bacterial infection (Table 2). Pneumonia made up the bulk of these episodes (18/32) and purulent bronchitis accounted

DISCUSSION

The patterns of infection in the isolated lung transplants described in this article are similar to those reported by some of the large heart-lung transplant centers.1, 2 The pattern is also not unlike that described by Krowka et al5 in 1985 and recently updated by Chan et al6 in bone marrow transplants. Clearly lung and heart-lung recipients are at high risk of infection— in excess of 60 percent in all currently available series. In addition, many of the infections appear to target the

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Manuscript received March 19; revision accepted August 19.

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