Epidemiology, Etiology and Prognosis of Pneumonia in Lung Transplantation Recipients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LISai-qi , PANYan , WENGWei-qiong , LIXin , YANGMin ,  SHIJian-xin ,  SHENTUYang

Surgical Intensive Care Unit, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, P. R. China;

Corresponding author：

SHIJian-xin, Email: sjx.sch@126.com; SHENTUYang, Email: yang_shentu@163.com

Keywords：

Lung transplantation; post-operative complications; pneumonia

DOI：

10.7507/1007-4848.20150237

Video：

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Objective To investigate the epidemiology, etiology and prognosis of pneumonia in lung transplantation recipients. Methods We retrospectively analyzed the follow-up data of 42 case times (40 patients) of allogenic lung transplantation between March 2005 and August 2014. There were 29 males and 11 females with a mean age of 52.4±13.8 years. There were 32 case times with double lung transplantation, and 10 case times with single lung transplantation. Two patients underwent lung transplantation twice at an interval of 6.5 years and 4.0 years, respectively. Results In 42 case times of lung transplantation, 26 case times had forty-two episodes of pneumonia throughout the follow-up period of median 146 days (range 3 to 2 704 days). Microbiological etiology was established in 36 case times of pneumonia. Bacterial pneumonia (68.1%) was more frequent than fungal (10.6%) and viral pneumonia (8.5%). The cumulative risk of a pneumonia episode increased sharply in the first 30 days after transplantation. A percentage of 38.1% of total pneumonia episodes occurred within 30 days after transplantation, predominately due to Gram negative bacilli. While pneumonia of gram-negative bacilli occurred earliest with a median of 20 days (range 8-297 days). pneumonia caused by viruses (283 days, range 186-482 days) appeared significantly later than gram-negative bacilli, and unknown etiology (44.5 days, range 3-257 days) (P=0.001 and P=0.019, respectively). The survival rate in 1 year, 3 years, and 5 years was 66.1%, 56.3%, and 36.2%, respectively. pneumonia episode within 30 days after lung transplantation was associated remarkably with mortality risk (P=0.03) in lung transplantation recipients. The total blood loss during transplantation procedure and post-transplantation intubation time were associated significantly with early onset of pneumonia (≤30 days) by univariate analysis. Conclusion Recognition of epidemiology, etiology and chronology of post-transplantaion pneumonia has implications relevant for appropriate management and optimal antibiotic prescription in lung transplantation recipients.

Citation： LISai-qi, PANYan, WENGWei-qiong, LIXin, YANGMin, SHIJian-xin, SHENTUYang. Epidemiology, Etiology and Prognosis of Pneumonia in Lung Transplantation Recipients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(10): 948-953. doi: 10.7507/1007-4848.20150237 Copy

1.	Chaparro C,Maurer JR,Chamberlain D,et al.Causes of death in lung transplant recipients.J Heart Lung Transplant,1994,13(5):758-766.
2.	Horvath J,Dummer S,Loyd J,et al.Infection in the transplanted and native lung after single lung transplantation.Chest,1993,10(3):681-685.
3.	施建新,赵珩,潘旭峰,等.双肺移植治疗终末期良性肺病40例.中华胸心血管外科杂志,2013,29(5):286-289.
4.	Yusen RD,Edwards LB,Kucheryavaya AY,et al.The registry of the International Society for Heart and Lung Transplantation:thirty-first adult lung and heart-lung transplant report——2014;focus theme:retransplantation.J Heart Lung Transplant,2014,33(10):1009-1024.
5.	Aguilar-Guisado M,Givalda J,Ussetti p,et al.pneumonia after lung transplantation in the RESITRA Cohort:a multicenter prospective study.Am J Transplant,2007,7(8):1989-1896.
6.	San Juan R,Aguado JM,Lumbreras C,et al.Incidence,clinical characteristics and risk factors of late infection in solid organ transplant recipients:data from the RESITRA study group.Am J Transplant,2007,7(4):964-971.
7.	Sims KD,Blumberg.EA Common infections in the lung transplant recipient.Clin Chest Med,2011,32(2):327-341.
8.	Campos S,Caramori M,Teixeira R,et al.Bacterial and fungal pneumonias after lung transplantation.Transplant proc,2008,40(3):822-824.
9.	Weigt SS,Elashoff RM,Huang C,et al.Aspergillus colonization of the lung allograft is a risk factor for bronchiolitis obliterans syndrome.Am J Transplant,2009,9(8):1903-1911.
10.	Valentine VG,Gupta MR,Walker JE Jr,et al.Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome.J Heart Lung Transplant,2009,28(2):163-169.
11.	Hayes D Jr.A review of bronchiolitis obliterans syndrome and therapeutic strategies.J Cardiothorac Surg,2011,6:92.
12.	Snydman DR,Limaye Ap,potena L,et al.Update and review:stateof-the-art management of cytomegalovirus infection and disease following thoracic organ transplantation.Transplant proc,2011,43(3 Suppl):S1-S17.
13.	paradis IL,Williams p.Infection after lung transplantation.Semin Respir Infect,1993,8(3):207-215.
14.	Maurer JR,Tullis DE,Grossman RF,et al.Infectious complications following isolated lung transplantation.Chest,1992,101(4):1056-1059.
15.	Husain S,McCurry K,Dauber J,et al.Nocardia infection in lung transplant recipients.J Heart Lung Transplant,2002,21(3):354-359.
16.	Campos S,Caramori M,Teixeira R,et al.Bacterial and fungal pneumonias after lung transplantation.Transplant proc,2008,40(3):822-824.
17.	Bonde pN,patel ND,Borja MC,et al.Impact of donor lung organisms on post-lung transplant pneumonia.J Heart Lung Transplant,2006,25(1):99-105.
18.	Rubin RH.Infection in the organ transplant recipient.In:Rubin RH,Young LS,(eds).Clinical approach to infection in the compromisedhost,3rd ed.New York,N.Y:plenum Medical Book Co,1994.629-705.
19.	Hadjiliadis D,Chaparro C,Gutierrez C,et al.Impact of lung transplant operation on bronchiolitis obliterans syndrome in patients with chronic obstructive pulmonary disease.Am J Transplant,2006,6(1):183-189.
20.	Horvath J,Dummer S,Loyd J,et al.Infection in the transplanted and native lung after single lung transplantation.Chest,1993,104(3):681-685.
21.	porhownik NR.Airway complications post lung transplantation.Curr Opin pulm Med,2013,19(2):174-180.
22.	Ahmad S,Shlobin OA,Nathan SD.pulmonary complications of lung transplantation.Chest,2011,139(2):402-411.
23.	Barnard JB,Davies O,Curry p,et al.Size matching in lung transplantation:an evidence-based review.J Heart Lung Transplant,2013,32(9):849-860.
24.	陈静瑜,郑明峰,何毅军,等.65例肺移植手术的临床分析.中国胸心血管外科临床杂志,2009,16(5):385-388.

1. Chaparro C,Maurer JR,Chamberlain D,et al.Causes of death in lung transplant recipients.J Heart Lung Transplant,1994,13(5):758-766.
2. Horvath J,Dummer S,Loyd J,et al.Infection in the transplanted and native lung after single lung transplantation.Chest,1993,10(3):681-685.
3. 施建新,赵珩,潘旭峰,等.双肺移植治疗终末期良性肺病40例.中华胸心血管外科杂志,2013,29(5):286-289.
4. Yusen RD,Edwards LB,Kucheryavaya AY,et al.The registry of the International Society for Heart and Lung Transplantation:thirty-first adult lung and heart-lung transplant report——2014;focus theme:retransplantation.J Heart Lung Transplant,2014,33(10):1009-1024.
5. Aguilar-Guisado M,Givalda J,Ussetti p,et al.pneumonia after lung transplantation in the RESITRA Cohort:a multicenter prospective study.Am J Transplant,2007,7(8):1989-1896.
6. San Juan R,Aguado JM,Lumbreras C,et al.Incidence,clinical characteristics and risk factors of late infection in solid organ transplant recipients:data from the RESITRA study group.Am J Transplant,2007,7(4):964-971.
7. Sims KD,Blumberg.EA Common infections in the lung transplant recipient.Clin Chest Med,2011,32(2):327-341.
8. Campos S,Caramori M,Teixeira R,et al.Bacterial and fungal pneumonias after lung transplantation.Transplant proc,2008,40(3):822-824.
9. Weigt SS,Elashoff RM,Huang C,et al.Aspergillus colonization of the lung allograft is a risk factor for bronchiolitis obliterans syndrome.Am J Transplant,2009,9(8):1903-1911.
10. Valentine VG,Gupta MR,Walker JE Jr,et al.Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome.J Heart Lung Transplant,2009,28(2):163-169.
11. Hayes D Jr.A review of bronchiolitis obliterans syndrome and therapeutic strategies.J Cardiothorac Surg,2011,6:92.
12. Snydman DR,Limaye Ap,potena L,et al.Update and review:stateof-the-art management of cytomegalovirus infection and disease following thoracic organ transplantation.Transplant proc,2011,43(3 Suppl):S1-S17.
13. paradis IL,Williams p.Infection after lung transplantation.Semin Respir Infect,1993,8(3):207-215.
14. Maurer JR,Tullis DE,Grossman RF,et al.Infectious complications following isolated lung transplantation.Chest,1992,101(4):1056-1059.
15. Husain S,McCurry K,Dauber J,et al.Nocardia infection in lung transplant recipients.J Heart Lung Transplant,2002,21(3):354-359.
16. Campos S,Caramori M,Teixeira R,et al.Bacterial and fungal pneumonias after lung transplantation.Transplant proc,2008,40(3):822-824.
17. Bonde pN,patel ND,Borja MC,et al.Impact of donor lung organisms on post-lung transplant pneumonia.J Heart Lung Transplant,2006,25(1):99-105.
18. Rubin RH.Infection in the organ transplant recipient.In:Rubin RH,Young LS,(eds).Clinical approach to infection in the compromisedhost,3rd ed.New York,N.Y:plenum Medical Book Co,1994.629-705.
19. Hadjiliadis D,Chaparro C,Gutierrez C,et al.Impact of lung transplant operation on bronchiolitis obliterans syndrome in patients with chronic obstructive pulmonary disease.Am J Transplant,2006,6(1):183-189.
20. Horvath J,Dummer S,Loyd J,et al.Infection in the transplanted and native lung after single lung transplantation.Chest,1993,104(3):681-685.
21. porhownik NR.Airway complications post lung transplantation.Curr Opin pulm Med,2013,19(2):174-180.
22. Ahmad S,Shlobin OA,Nathan SD.pulmonary complications of lung transplantation.Chest,2011,139(2):402-411.
23. Barnard JB,Davies O,Curry p,et al.Size matching in lung transplantation:an evidence-based review.J Heart Lung Transplant,2013,32(9):849-860.
24. 陈静瑜,郑明峰,何毅军,等.65例肺移植手术的临床分析.中国胸心血管外科临床杂志,2009,16(5):385-388.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Epidemiology, Etiology and Prognosis of Pneumonia in Lung Transplantation Recipients

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