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Opportunistic bronchopulmonary infections after lung transplantation: clinical and radiographic findings
R Shreeniwas1, L L Schulman, Y M Berkmen
1Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
Purpose:
To assess clinical and radiographic findings in opportunistic bronchopulmonary infections after lung transplantation.
Materials And Methods:
Forty-five episodes of opportunistic bronchopulmonary infection occurred in 27 (35%) of 77 lung transplant recipients during a 4-year period. Causative organisms, radiographic patterns, and mortality were reviewed.
Results:
Cytomegalovirus (CMV) was the most common pathogen (25 episodes), followed by Aspergillus species (seven episodes), Pneumocystis carinii (six episodes), herpes simplex virus (four episodes), Mycobacterium avium complex (two episodes), and M tuberculosis (one episode). Eighteen of the 25 episodes (72%) of CMV pneumonitis occurred in the first 4 months after transplantation; 24 (96%) occurred within the 1st year. Radiographic patterns of symptomatic CMV pneumonitis were diffuse haziness (60%), focal haziness (33%), and focal consolidation (7%). Aspergillus species locally invaded a necrotic bronchial anastomosis in three patients, each within 4 months of transplantation. P carinii was seen as focal haziness and caused no symptoms. Radiographic findings, when present, were seen almost exclusively in the transplanted lung. Despite three deaths attributable to opportunistic bronchopulmonary infection, the difference between the survival rates of patients with and those of patients without bronchopulmonary infection was not statistically significant (82% and 81%, respectively, 1 year after transplantation).
Conclusion:
Opportunistic bronchopulmonary infections are common after lung transplantation. The most common pathogen is CMV, which causes diverse chest radiographic patterns. Opportunistic bronchopulmonary infections do not adversely affect overall mortality.
Insights
Opportunistic bronchopulmonary infections are common after lung transplantation, with cytomegalovirus (CMV) being the most frequent cause. These infections, however, do not significantly impact long-term survival rates in lung transplant recipients.
Area of Science:
- Pulmonary Medicine
- Transplant Surgery
- Infectious Diseases
Background:
- Lung transplantation is a life-saving procedure for end-stage lung disease.
- Opportunistic infections pose a significant risk to lung transplant recipients.
- Understanding these infections is crucial for patient management and outcomes.
Purpose of the Study:
- To evaluate the clinical and radiographic characteristics of opportunistic bronchopulmonary infections following lung transplantation.
- To identify common pathogens and their associated radiographic patterns.
- To assess the impact of these infections on patient mortality.
Main Methods:
- A retrospective review of 77 lung transplant recipients over a 4-year period.
- Analysis of 45 episodes of opportunistic bronchopulmonary infections.
- Identification of causative organisms, radiographic findings, and mortality data.
Main Results:
- Cytomegalovirus (CMV) was the most prevalent pathogen (25 episodes), followed by Aspergillus and Pneumocystis carinii.
- CMV pneumonitis typically occurred within the first year post-transplant, presenting with diverse radiographic patterns.
- Opportunistic infections were primarily observed in the transplanted lung, and did not significantly affect overall 1-year survival rates (82% with infection vs. 81% without).
Conclusions:
- Opportunistic bronchopulmonary infections are a frequent complication after lung transplantation.
- Cytomegalovirus (CMV) is the leading cause, manifesting with varied radiographic presentations.
- Despite their occurrence, these infections do not appear to adversely influence long-term mortality in lung transplant recipients.