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An Update in Antimicrobial Therapies and Infection Prevention in Pediatric Lung Transplant Recipients
O C Smibert1, M A Paraskeva2, G Westall2
1Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC, 3004, Australia.
Insights
Managing infections in pediatric lung transplant recipients is crucial for survival. Aggressive pre-transplant care and novel strategies are key to improving outcomes for these vulnerable patients.
Area of Science:
- Pediatric pulmonology
- Transplant infectious diseases
- Critical care medicine
Background:
- Lung transplantation offers life-saving treatment for children with end-stage lung disease.
- Infectious complications significantly impact morbidity and mortality in pediatric lung transplant recipients.
- Organism types include bacteria, viruses, and fungi, acquired pre- or post-transplant.
Purpose of the Study:
- To outline the management of infectious complications in pediatric lung transplant recipients.
- To emphasize the importance of pre-transplant infection management, especially in cystic fibrosis patients.
- To discuss the implications of using expanded-criteria donors in pediatric lung transplantation.
Main Methods:
- Review of current literature on pediatric lung transplant infectious complications.
- Analysis of pre-transplant management strategies for high-risk organisms like multidrug-resistant bacteria, fungi, and Mycobacterium abscessus.
- Evaluation of the safety and outcomes of using expanded-criteria donors in pediatric lung transplantation.
Main Results:
- Optimal pre-transplant management, including vaccination and antibiotic-sparing strategies, is vital for post-transplant outcomes.
- Pediatric lung transplant programs will likely encounter increased-risk donors due to rising transplant demands.
- Novel antibiotic-sparing therapies are emerging to address current infectious challenges.
Conclusions:
- Comprehensive management of pre- and post-transplant infections is essential for pediatric lung transplant success.
- Proactive strategies are needed to mitigate risks associated with infections and expanded-criteria donors.
- Advancements in therapeutic approaches hold promise for improving long-term outcomes.
Abstract:
Lung transplantation can offer life-prolonging therapy to children with otherwise terminal end-stage lung disease. However, infectious complications, like those experienced by their adult counterparts, are a significant cause of morbidity and mortality. These include bacteria, viruses, and fungi that infect the patient pretransplant and those that may be acquired from the donor or by the recipient in the months to years posttransplant. An understanding of the approach to the management of each potential infecting organism is required to ensure optimal outcomes. In particular, emphasis on aggressive preoperative management of infections in pediatric patients with cystic fibrosis is important. These include multidrug-resistant Gram-negative bacteria, fungi, and Mycobacterium abscessus, the posttransplant outcome of which depends on optimal pretransplant management, including vaccination and other preventive, antibiotic-sparing strategies. Similarly, increasing the transplant donor pool to meet rising transplant demands is an issue of critical importance. Expanded-criteria donors-those at increased risk of blood-borne viruses in particular-are increasingly being considered and transplants undertaken to meet the rising demand. There is growing evidence in the adult pool that these transplants are safe and associated with comparable outcomes. Pediatric transplanters are therefore likely to be presented with increased-risk donors for their patients. Finally, numerous novel antibiotic-sparing therapeutic approaches are on the horizon to help combat infections that currently compromise transplant outcomes.
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