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Updated: Jul 5, 2026

Murine Intrapulmonary Tracheal Transplantation: A Model for Investigating Obliterative Airway Disease After Lung Transplantation
Published on: November 10, 2023
Bacterial and fungal pneumonias after lung transplantation
S Campos1, M Caramori, R Teixeira
1Lung Transplant Group, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. silviavcampos@uol.com.br
Objective:
The aim of this study was to evaluate the epidemiology of bacterial and fungal pneumonia in lung transplant (LT) recipients and to assess donor-to-host transmission of these microorganisms.
Materials And Methods:
We retrospectively studied all positive cultures from bronchoalveolar lavage (BAL) of 49 lung transplant recipients and their donors from August 2003 to April 2007.
Results:
There were 108 episodes of pneumonia during a medium follow-up of 412 days (range, 1-1328 days). The most frequent microorganisms were: Pseudomonas aeruginosa (n = 36; 33.3%), Staphylococcus aureus (n = 29; 26.8%), and Aspergillus spp. (n = 18; 16%). Other fungal infections were due to Fusarium spp., Cryptococcus neoformans, and Paracoccidioides brasiliensis. Of the 31 donors with positive BAL, 15 had S. aureus. There were 21 pretransplant colonized recipients (43%) and 16 of them had suppurative underlying lung disease. P. aeruginosa was the most frequent colonizing organism (59% of pretransplant positive cultures). There were 11 episodes of bacteremia and lungs were the source in 5 cases. Sixteen deaths occurred and 6 (37.5%) were due to infection. Statistical analyses showed association between pretransplant colonizing microorganisms from suppurative lung disease patients and pneumonias after lung transplantation (RR = 4.76; P = .04; 95% CI = 1.02-22.10). No other analyzed factor was significant.
Conclusions:
Bacterial and fungal infections are frequent and contribute to higher mortality in lung transplant recipients. P. aeruginosa is the most frequent agent of respiratory infections. This study did not observe any impact of donor lung organisms on pneumonia after lung transplantation. Nevertheless, we demonstrated an association between pretransplant colonizing microorganisms and early pneumonias in suppurative lung transplant recipients.
Insights
Bacterial and fungal pneumonia are common after lung transplantation, with Pseudomonas aeruginosa being the most frequent cause. Donor organisms did not impact pneumonia risk, but pre-existing colonization in patients with lung disease increased risk.
Area of Science:
- Transplant Infectious Diseases
- Pulmonary Medicine
- Microbiology
Background:
- Lung transplant recipients face significant risks of bacterial and fungal pneumonia.
- Understanding the epidemiology and transmission of these infections is crucial for patient outcomes.
Purpose of the Study:
- To investigate the epidemiology of bacterial and fungal pneumonia in lung transplant recipients.
- To assess the role of donor-to-host transmission in these post-transplant infections.
- To identify risk factors associated with pneumonia development.
Main Methods:
- Retrospective analysis of bronchoalveolar lavage (BAL) cultures from 49 lung transplant recipients and their donors.
- Data collected from August 2003 to April 2007.
- Evaluation of pneumonia episodes, causative microorganisms, and pre-transplant colonization.
Main Results:
- 108 pneumonia episodes occurred, with Pseudomonas aeruginosa (33.3%), Staphylococcus aureus (26.8%), and Aspergillus spp. (16%) being most common.
- Pre-transplant colonization was present in 43% of recipients, particularly those with underlying suppurative lung disease.
- An association was found between pre-transplant colonization and early post-transplant pneumonia (RR = 4.76, P = .04).
- No significant impact of donor lung organisms on pneumonia development was observed.
Conclusions:
- Bacterial and fungal infections are frequent complications in lung transplant recipients, contributing to mortality.
- Pseudomonas aeruginosa is the predominant pathogen causing respiratory infections.
- Pre-transplant colonization, especially in patients with suppurative lung disease, is a significant risk factor for early post-transplant pneumonia.
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