Respiratory infections following organ transplantation

Successful organ transplantation often is limited by infection. The early transplant period is predominated by bacterial and fungal infections related to surgery and neutropenia, whereas opportunistic infections occur later due to long-term immunosuppression therapy. Despite technical differences between various types of organ transplants, the diagnostic approaches to lung disease are similar and rely largely on fiberoptic bronchoscopy. Whereas better antibacterial prophylaxis is available, fungal infections are emerging as significant problems. Lipid suspension formulations of amphotericin B and itraconazole offer new treatment options for fungal pulmonary infection. These formulations appear to have improved pharmacologic safety, but relative efficacy is unclear. Cytomegalovirus infections continue to plague transplant recipients. Improved understanding of the risk factors (especially the role of screened blood products) and improved prophylactic strategies with ganciclovir and immunoglobulin are decreasing the incidence of fatal infection. Surveillance for viremia and antigenemia now permit early identification of patients at significant risk for clinical disease, and responses to prompt administration of ganciclovir are encouraging, especially among solid organ recipients.