Infections in Lung Transplant Recipients during and after Prophylaxis
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Background: The timeline of infections after lung transplantation has been changed with the introduction of new immunosuppressants and prophylaxis strategies. The study aimed to investigate the epidemiological characteristics of infectious diseases after lung transplantation in the current era. Materials and Methods: All patients who underwent lung or heart–lung transplantation at our institution between October 29, 2008 and April 3, 2019 were enrolled. We retrospectively reviewed the patients' medical records till April 2, 2020. Results: In total, 100 consecutive lung transplant recipients were enrolled. The median follow-up period was 28 months after lung transplantation. A total of 127 post–lung transplantation bacterial infections occurred. Catheter-related bloodstream infection (25/84, 29.8%) was the most common within 6 months and pneumonia (23/43, 53.5%) was the most common after 6 months. Most episodes (35/40, 87.5%) of respiratory viral infections occurred after 6 months, mainly as upper respiratory infections. The remaining episodes (5/40, 12.5%) mostly manifested as lower respiratory tract infections. Seventy cytomegalovirus infections observed in 43 patients were divided into 23 episodes occurring before and 47 episodes occurring after discontinuing prophylaxis. Of 10 episodes of cytomegalovirus disease, four occurred during prophylaxis and six occurred after prophylaxis. Of 23 episodes of post–lung transplantation fungal infection, 7 were aspergillosis and all occurred after the discontinuation of prophylaxis. Conclusion: Lung transplant recipients experienced a high burden of infection even after 6 months, especially after the end of the prophylaxis period. Therefore, these patients should be continued to be monitored long-term for infectious disease.
Abstract
Background: The timeline of infections after lung transplantation has been changed with the introduction of new immunosuppressants and prophylaxis strategies. The study aimed to investigate the epidemiological characteristics of infectious diseases after lung transplantation in the current era. Materials and Methods: All patients who underwent lung or heart–lung transplantation at our institution between October 29, 2008 and April 3, 2019 were enrolled. We retrospectively reviewed the patients' medical records till April 2, 2020. Results: In total, 100 consecutive lung transplant recipients were enrolled. The median follow-up period was 28 months after lung transplantation. A total of 127 post–lung transplantation bacterial infections occurred. Catheter-related bloodstream infection (25/84, 29.8%) was the most common within 6 months and pneumonia (23/43, 53.5%) was the most common after 6 months. Most episodes (35/40, 87.5%) of respiratory viral infections occurred after 6 months, mainly as upper respiratory infections. The remaining episodes (5/40, 12.5%) mostly manifested as lower respiratory tract infections. Seventy cytomegalovirus infections observed in 43 patients were divided into 23 episodes occurring before and 47 episodes occurring after discontinuing prophylaxis. Of 10 episodes of cytomegalovirus disease, four occurred during prophylaxis and six occurred after prophylaxis. Of 23 episodes of post–lung transplantation fungal infection, 7 were aspergillosis and all occurred after the discontinuation of prophylaxis. Conclusion: Lung transplant recipients experienced a high burden of infection even after 6 months, especially after the end of the prophylaxis period. Therefore, these patients should be continued to be monitored long-term for infectious disease.
참고문헌 (24)
- "ORTN (Organ procurement and transplantation network)/ SRTR (Scientific registry of transplant recipients) 2018 annual data report: lung"[URL]
- Fishman JA, "Infection in organ-transplant recipients", N Engl J Med, 338, pp.1741~1751 (1998)
- Fishman JA, "Infection in solid-organ transplant recipients", N Engl J Med, 357, pp.2601~2614 (2007)
- van Delden C, "Burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss transplant cohort study", Clin Infect Dis, 71, pp.e159~e169 (2020)
- Lanini S, "Incidence of carbapenemresistant gram negatives in Italian transplant recipients : a nationwide surveillance study", PLoS One, 10, pp.e0123706~ (2015)
- Hakimi Z, "Burden of cytomegalovirus disease in solid organ transplant recipients: a national matched cohort study in an inpatient setting", Transpl Infect Dis, pp.19~ (2017)
- Hosseini-Moghaddam SM, "Incidence and outcomes of invasive fungal infection among solid organ transplant recipients : A population-based cohort study", Transpl Infect Dis, 22, pp.e13250~ (2020)
- Beam E, "Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis", Clin Transplant, 30, pp.270~278 (2016)
- He SY, "Practice variation in Aspergillus prophylaxis and treatment among lung transplant centers : a national survey", Transpl Infect Dis, 17, pp.14~20 (2015)
- 윤지현, "Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies", The Korean Journal of Internal Medicine, 30(4), pp.506~514 (2015), 대한내과학회[DOI]
- Sweet SC, "Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes : Results of the CTOTC-03 study", Am J Transplant, 19, pp.3284~3298 (2019)
- Humar A, "American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation", Am J Transplant, 6, pp.262~274 (2006)
- Raad I, "Differential time to positivity : a useful method for diagnosing catheter-related bloodstream infections", Ann Intern Med, 140, pp.18~25 (2004)
- Stewart S, "Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection", J Heart Lung Transplant, 26, pp.1229~1242 (2007)
- Verleden GM, "A new classification system for chronic lung allograft dysfunction", J Heart Lung Transplant, 33, pp.127~133 (2014)
- Ljungman P, "Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials", Clin Infect Dis, 64, pp.87~91 (2017)
- Giannella M, "Pneumonia in solid organ transplant recipients : a prospective multicenter study", Transpl Infect Dis, 16, pp.232~241 (2014)
- Tebano G, "Epidemiology and risk factors of multidrug-resistant bacteria in respiratory samples after lung transplantation", Transpl Infect Dis, 18, pp.22~30 (2016)
- Riera J, "Ventilator-associated respiratory infection following lung transplantation", Eur Respir J, 45, pp.726~737 (2015)
- Silva JT, "Multidrug-resistant Gram-negative infection in solid organ transplant recipients : implications for outcome and treatment", Curr Opin Infect Dis, 31, pp.499~505 (2018)
- Konishi Y, "Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia", Gen Thorac Cardiovasc Surg, 68, pp.833~840 (2020)
- Bridevaux PO, "Incidence and outcomes of respiratory viral infections in lung transplant recipients : a prospective study", Thorax, 69, pp.32~38 (2014)
- Park SY, "Efficacy of a strategy for discontinuing pre-emptive ganciclovir therapy after a negative cytomegalovirus antigenaemia test result in seropositive kidney transplant recipients", J Antimicrob Chemother, 68, pp.1209~1211 (2013)
- Lee SO, "Comparison of higher dose and lower dose ganciclovir for cytomegalovirus prophylaxis in seropositive heart transplant recipients", Transpl Infect Dis, 12, pp.31~37 (2010)