INFECTION IN THE TRANSPLANTED AND NATIVE LUNG AFTER SINGLE-LUNG TRANSPLANTATION

Objective: To analyze a single-center experience with infectious compl ications of single lung transplantation (SLT) with special emphasis on risk factors for infection in the transplanted and native lung. Desig n: Consecutive case series. Setting. University teaching hospital. Pat ients: Fifteen consecutive SLT recipients (mean age, 43 years; 9 men a nd 6 women). Mean follow-up was 337 days. Results: Fifteen patients ha d 24 infectious episodes (1.6 per patient) of which 83 percent were li fe-threatening, 79 percent involved the lung, airway, or pleural space , and 79 percent occurred in the first 4 months after transplantation. Despite this high infectious morbidity, there were no infectious deat hs. The most important infections were bacterial pneumonia (n = 10), c ytomegalovirus (CMV) pneumonia (n = 5), and bronchial anastomotic infe ctions (n = 3). Significant risk factors for bacterial pneumonia were a diagnosis of primary or secondary pulmonary hypertension (p<0.05) an d the presence of airway complications of stenosis or dehiscence (p<0. 05). No risk factors for overall lung infections were identified. The native lung was involved in 6 of 16 lung infections and was the exclus ive site of infection in 4 cases. Underlying disease in the native lun g may have predisposed to infection at that site by a mechanism of ina dequate blood flow or impaired ventilation. Three bronchial anastomoti c infections (Pseudomonas, Candida, Aspergillus) occurred, all with de hiscence of the anastomosis. These were highly morbid but resolved wit h antibiotics, stent placement, and surgical retention in two of the t hree cases. The five episodes of CMV pneumonia caused mild (four patie nts) or moderate (one patient) dysfunction and responded to antiviral agents without relapse. Conclusion: The frequency, complexity, and mor bidity of infections after SLT were great, but most infections were ma nageable and good outcomes were achieved. A pretransplant diagnosis of pulmonary hypertension or posttransplant occurrence of bronchial sten osis or dehiscence were associated with a higher rate of bacterial pne umonia. The underlying disease in the native lung may predispose to in fection at that site.