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Pulmonary infection after cardiac transplantation: clinical and radiologic correlations
J H Austin1, L L Schulman, J D Mastrobattista
1Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032.
Abstract:
Forty-one episodes of radiographically demonstrated pulmonary infection developed in 35 (30%) of 118 cardiac transplant recipients treated with cyclosporine. The most common pathogens were cytomegalovirus (CMV) (13 episodes), Pneumocystis carinii (12 episodes), and Aspergillus (five episodes). Appearance of CMV infection on radiographs was generalized and hazy (n = 9) or limited to one lobe (n = 4). All episodes of P carinii pneumonia, including six combined with CMV infection, appeared diffusely hazy. Aspergillus infection appeared either shaggy and nodular (n = 3) or bibasilar and hazy (n = 2). Aspergillus infection developed only early after transplantation (0.2-2.5 months), whereas CMV infection (1.1-6.1 months) and P carinii pneumonia (2.6-10.3 months) developed later (time ranges for latter two infections exclude three episodes that developed even later in two patients at risk for acquired immunodeficiency syndrome). Nine (8%) patients died of pulmonary infection, eight (7%) within 4.0 months of transplantation. Symptoms or signs were variable; none were found in four (10%) of 41 episodes. The authors recommend frequent chest radiographs in the early months after transplantation.
Insights
Pulmonary infections are common in cardiac transplant recipients on cyclosporine. Cytomegalovirus, Pneumocystis carinii, and Aspergillus are the most frequent culprits, necessitating early chest radiography surveillance.
Area of Science:
- Medicine
- Immunology
- Infectious Diseases
Background:
- Cardiac transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.
- Cyclosporine, an immunosuppressive agent, is commonly used post-transplantation, potentially increasing infection risk.
Purpose of the Study:
- To identify the incidence, pathogens, and radiographic patterns of pulmonary infections in cardiac transplant recipients treated with cyclosporine.
- To determine the timing and outcomes of these infections.
Main Methods:
- Retrospective review of 118 cardiac transplant recipients treated with cyclosporine.
- Analysis of 41 episodes of radiographically demonstrated pulmonary infections.
- Identification of causative pathogens and their radiographic appearances.
Main Results:
- 30% of recipients (35/118) developed pulmonary infections.
- Most common pathogens: cytomegalovirus (CMV), Pneumocystis carinii, and Aspergillus.
- CMV infections appeared hazy or lobar; P carinii pneumonia was diffusely hazy; Aspergillus was nodular or hazy.
- Infections occurred at varying times post-transplant, with Aspergillus early and CMV/P carinii later.
- 8% of patients died from pulmonary infections, mostly within 4 months.
Conclusions:
- Pulmonary infections are a significant complication in cardiac transplant recipients on cyclosporine.
- Specific radiographic patterns can suggest particular pathogens.
- Early and frequent chest radiography is recommended for surveillance in the post-transplant period.