Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies

BACKGROUND/AIMS: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. METHODS: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records. RESULTS: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. CONCLUSIONS: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.

Bronchiolitis obliterans syndrome after heart-lung transplantation: a case report and review of literature.

Bronchiolitis obliterans syndrome (BOS) is regarded as a manifestation of chronic rejection after lung transplantation and remains the major cause of late morbidity and mortality after lung and heart-lung transplantation. The authors, herein, reported the first documented case of a patient who receiving heart-lung transplantation at our institute and developed BOS as a late complication. The patient presented 5 years after received heart-lung transplantation with progressive shortness of breath due to obstructive lung disease. He was diagnosed with BOS by typical clinical presentation, pulmonary function test and radiographic findings and there were no other identified etiologies of airway obstruction. The authors also reviewed the recent update on the diagnosis and management of BO after lung transplantation.

Gastric Ulcer Perforation in Heart-Lung Transplant Patient: A Successful Case of Early Surgical Intervention and Management

Gastrointestinal complications may follow organ transplantation. A patient who underwent heart lung transplantation due to patent ductus arteriosus and Eisenmenger's syndrome had an episode of acute cardiac rejection and was treated with a bolus injection of methylprednisolone followed by a high oral dose of prednisone. On the 22nd postoperative day, the patient complained of acute abdominal pain with muscular rigidity and a plain chest x-ray showed free air in the right subdiaphragmatic area. Under the suspicion of bowel perforation, an emergency laparotomy was performed and the perforated stomach had a wedge-shaped resection that included the perforation. Following the laparotomy, the postoperative course was uneventful and the patient was discharged on post-laparotomy day 10.

Trasplante de corazón-pulmón

El trasplante de corazón-pulmon es parte del arsenal terapéutico en enfermos respiratorios terminales con compromiso cardíaco secundario, en quienes la probabilidad de vida es menor de un año sin el recurso de trasplante. Se presenta una revisión del estado actual del trasplante del bloque del corazón-pulmón. Se plantean las ventajas sobre el trasplante simple de pulmón y las diferencias con el trasplante cardíaco.