RESUMO
BACKGROUND: Due to the complex therapy and the required high level of immunosuppression, lung recipients are at high risk to develop many different long term complications. METHODS: From 1993-2000, a total of 54 lung transplantation (LuTx) were performed at our center. Complications, graft and patient survival of this cohort was retrospectively analyzed. RESULTS: One/five and ten-year patient survival was 71.4%, 41.2% and 25.4%; at last follow up (4/2010), twelve patients were alive. Of the 39 deceased patients, 26 died from infectious complications. Other causes of death were myocardial infarction (n=1), progressive graft failure (n=1), intracerebral bleeding (n=2), basilary vein thrombosis (n=1), pulmonary emboli (n=1), others (n=7). Surgical complication rate was 27.7% during the first year and 25% for the 12 long term survivors. Perioperative rejection rate was 35%, and 91.6% for the 12 patients currently alive. Infection incidence during first hospitalization was 79.6% (1.3 episodes per transplant) and 100% for long term survivors. Commonly isolated pathogens were cytomegalovirus (56.8%), Aspergillus (29.4%), RSV (13.7%). Other common complications were renal failure (56.8%), osteoporosis (54.9%), hypertension (45%), diabetes mellitus (19.6%). CONCLUSIONS: Infection and rejection remain the most common complications following LuTx with many other events to be considered.
RESUMO
Bacterial infection remains a major problem after solid organ transplantation (SOT), especially in children. Piperacillin-tazobactam (Pip-Tazo) is a beta-lactam-antibiotic combination with a broad spectrum of activity including gram-positive cocci as well as gram-negative rods, non-fermentative and anaerobic bacteria. The aim of this retrospective study was to critically review our experience with Pip-Tazo as perioperative prophylactic agent in pediatric non-renal SOT. Between 1993 and 2003 Pip-Tazo was used as initial perioperative prophylaxis in 45 pediatric patients who underwent a total of 49 transplants (36 liver-, seven cardiac-, two lung-, and four small bowel-) at our department. Median age of the children was 7.9 (range 0.5-18.1) years. A total of 34 rejection episodes following 27 transplants were diagnosed. During first hospitalization 44 infectious episodes were observed. Bacteria were responsible for 22 episodes including sepsis (n = 10), pneumonia (n = 5), wound infection (n = 4), urinary tract infection (n = 1), and clostridial colitis (n = 2). The isolated organisms were gram-positive cocci (n = 12), gram-negative rods (n = 3), non-fermentative bacilli (n = 4), and anaerobes (n = 3). Ten episodes were caused by Pip-Tazo resistant bacteria. Twenty-one of these infections were observed following antirejection therapy with pulse steroids. At later time points nine infectious episodes were successfully treated with a second course of Pip-Tazo. During follow up, eight patients died. Six deceased perioperatively: five from infection including aspergillosis (n = 4) and Pneumocystis jiroveci pneumonia (n = 1) and cerebrovascular bleeding (n = 1) and two children later on. At present 37 children (82%) are alive with well functioning graft after a median follow up of 39.2 (range 0.6-123.5) months. No severe side effects caused by Pip-Tazo were observed in any of the children. Pip-Tazo may be a suitable single agent for perioperative prophylaxis in pediatric non-renal solid organs recipients, however, a prospective comparative study is needed to make final conclusions.
