Anastomotic infections in lung transplant recipients

Anastomotic infections are an uncommon but potentially devastating complication after lung transplantation. The incidence, microbiology, predisposing factors, and clinical outcomes of anastomotic infections have not been well described.

We performed a retrospective chart review of the first 283 lung or heart-lung transplant recipients performed at Duke University Medical Center and identified all cases of anastomotic infection.

Fifteen patients (5.3%) developed anastomotic infections. Aspergillus caused infection in six patients, Candida in eight patients and Staphylococcus aureus in one patient. Bilateral or right lung transplantation and the use of induction immunosuppression with monoclonoal or polyclonal antibodies are associated with a higher incidence of anastomotic infections. All patients with fungal anastomotic infections were treated with a combination of systemic and inhaled antifungal agents. All patients had improvement of their anastomotic sites after treatment and no patients developed anastomotic dehiscence.

Anastomotic infection is an infrequent complication after lung transplantation, and is caused predominately by fungal pathogens. In contrast to previous reports, anastomotic dehiscence did not occur in any patient in our series. Treatment with the combination of inhaled and systemic antimicrobial agents may have favorably affected clinical outcomes.