Lung infections in pediatric lung transplantation: experience in 49 cases

Objectives: Pulmonary infections, and particularly cytomegalovirus (CMV) in fections, are a major cause of morbidity after lung transplantation. We rep ort here our results in 49 pediatric lung transplantations. Methods: Betwee n may 1988 and 1997, we have done 49 lung transplantations in 42 children t en bloc double lung transplantation (DLT):10, HLTx:7, sequential bilateral sequential-lung transplantation (BSLT):31, single-lung transplantation (SLT ): 1). in seven, it was a retransplantation. Among these, 34 were cystic fi brosis (CF) patients, all with multiresistant organisms (Pseudomonas aerugi nosa, Burkholderia cepacia, Achromobacter xylososydans, Staphyloccus aureus ). All patients were treated with multiantibiotic prophylaxy adapted to the preoperative cultures. Donor-recipient CMV matching was possible in only 3 1 cases. CMV prophylaxy and immunosuppression protocols have evolved with t ime, with a current protocol of IV Gancyclovir prophylaxy for 3 months and triple drug immunosuppression without past-operative rabbit anti-thymocyte globulin (RATG) induction. There was no perioperative mortality in the prim ary transplantations and three early deaths in the whole group (6.1%) Resul ts: Only five patients had no pulmonary infection. The patients presented 3 .2 infection episodes per year, 75% localized on the lungs, 41% during the first 3 months. Among the 13 deaths in the Ist year, 10 were directly relat ed to infection, 60% due to CMV. After the Ist year, in all patients dying of pulmonary dysfunction or obliterative bronchiolitis (OB), bacterial infe ctions were associated. There was no serious fungal infection. Actuarial su rvival at 3 months, 1, 3, 5 years were 85, 65.7, 47.5 and 28.5%, respective ly. There was a significant difference in 3 year survival between patients receiving CMV negative organs (40%) and CMV positive organs (17%). Conclusi on: In our experience, as in other's, pulmonary infection risk is important in lung transplantation. Bacterial infections were mainly an aggravating f actor of secondary pulmonary dysfunction or OB, and were not the primary ca use of death. CMV infections have been very severe and lead us, despite the scarcity of donors, to avoid positive donors in negative recipients, this leads to disastrous mid-term results In our experience, despite prophylaxis . (C) 1999 Elsevier Science B.V. All rights reserved.