Pulmonary complications in cardiac transplant recipients

Background: The incidence of pulmonary complications in heart transplant re cipients has not been extensively studied. We report pulmonary complication s in 159 consecutive adult orthotopic heart transplantations (OHTs) perform ed in 157 patients. Materials and methods: Retrospective review of medical records. Results: Forty-seven of 159 recipients (29.9%) had 81 pulmonary complicatio ns. Pneumonia was the most common (n = 27), followed by bronchitis (n = 15) , pleural effusion (n = 10), pneumothorax (n = 7), prolonged respiratory fa ilure requiring tracheotomy (n = 7), and obstructive sleep apnea syndrome ( n = 6). All patients with late-onset (> 6 months after transplantation) com munity-acquired bacteria] pneumonia presented with fever, cough, and a new lobar consolidation on the chest radiograph, and responded promptly to empi ric antibiotics without undergoing an invasive diagnostic procedure. in con trast, early-onset nosocomial bacterial pneumonias carried a 33.3% mortalit y rate. A positive tuberculin skin test result was associated with a signif icantly higher rate of pulmonary complications (62.5% vs 26.8%, p = 0.007). Lung cancer and posttransplant lymphoproliferative disorder (PTLD) develop ed exclusively in 6 of the 61 patients (8.1%) who received induction immuno suppression with murine monoclonal antibody (OKT3). Conclusion: Pulmonary complications are common following heart transplantat ion, occurring in 29.9% of recipients, and are attributed to pneumonia of p rimarily bacterial origin in one half of cases. Late-onset community-acquir ed pneumonia carried an excellent prognosis following empiric antibiotic th erapy, suggesting that in the appropriate clinical setting invasive diagnos tic procedures are unnecessary. Analogous to reports in other solid-organ t ransplant recipients, induction therapy with OKT3 was associated with an in creased incidence of lung cancer and PTLD. Overall, the development of pulm onary complications after OHT has prognostic significance given the higher mortality in this subset of patients.