Infections and lung transplantation: key considerations for eligibility, management, and posttransplant care

Lung transplantation is a critical and evolving therapy for patients with end-stage lung disease. As the need for lung transplantation increases, careful candidate selection is vital to maximizing outcomes and ensuring appropriate organ allocation. A key challenge in lung transplant candidates is the colonization or infection of the lungs by environmental and upper airway pathogens. These lung pathogens, along with other chronic infections, can lead to posttransplant complications with high mortality and an increased risk of graft failure.

Major infectious considerations for lung transplantation include colonization or infection by multidrug-resistant bacteria (including Burkholderia cepacia complex), nontuberculous mycobacteria, molds, and chronic viral infections. By recognizing the epidemiology, diagnosis, and management of these infections in the peri-transplant period, transplant providers can better mitigate infectious risks and improve transplant success. Similarly, advancements in diagnostics and therapeutics offer novel approaches to managing previously challenging infections.

As experience grows in treating these difficult infectious syndromes, more candidates are becoming eligible for transplantation. A thorough understanding of infectious considerations in lung transplant candidates is essential for improving candidate selection, reducing posttransplant complications, and expanding transplant eligibility.