Evaluation of infections in the lung transplant patient

Infections in lung transplant recipients (LTRs) are a serious complication that is associated with high mortality. Early and accurate diagnosis is critical in the management of these infections in order to achieve improved outcomes. This review focuses on studies published in the last 2 years related to the evaluation and management of infections following lung transplantation.

Valganciclovir is well tolerated and effective for long-term cytomegalovirus prophylaxis. Recently published guidelines recommend that foscarnet be added to ganciclovir for patients with life-threatening or sight-threatening disease while waiting for genotypic assay results because of ganciclovir-resistant strains. Mycobacterium abscessus has emerged as a significant pathogen in LTRs and should be eradicated in potential recipients before transplantation is performed. Preoperative Aspergillus colonization appears to not increase the risk of death after transplant. Azithromycin is protective against the development of bronchiolitis obliterans syndrome (BOS) and reduces mortality in LTRs. Eradication of Staphylococcus aureus in patients colonized prior to surgery can decrease postoperative surgical site infections from it by 80%. RNA interference therapy improves the symptoms of BOS in LTRs but does not have a direct antiviral effect.

Although life-saving for most recipients, lung transplantation can be complicated by serious postoperative infections. Additional prospective studies are needed to better elucidate the role of molecular testing in the diagnosis of infections, to determine whether eradication of S. aureus colonization improves outcomes in LTRs, and to further evaluate the role of RNA interference therapy for infections in LTRs.