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Twenty-four isolated double lung transplants (LTXs) have been performed in 22 patients with cystic fibrosis, with a follow-up of 4 to 47 months. Prior to LTX, all patients were colonized [...]

Study Objective: To ascertain the incidence, types , morbidity, and mortality of infectious episodes in isolated lung transplant recipients. Design: Retrospective chart review of patients who have undergone transplant over a six-year period in one institution. Patients: Twenty-three singled and 17 double lung transplants followed up between 2 and 68 months. Results: Fifty-one episodes of infection occurred in the group with a slight predominance in the double lung transplants. The 32 episodes of bacterial infection constituted the largest group of infection and more than half of these were pneumonias. Organisms identified were predominantly Gram negative. While bacterial processes made up the bulk of infections, fatalities were rare. Viral and fungal infections were less common, but more often fatal. Of six cases of viral pneumonitis, two were fatal; two of five cases of invasive fungal infection were also fatal. Overall, six patients died of infection. Conclusion: Our findings support previous reports from heart-lung centers documenting a high rate of infectious complications, particularly pneumonia, in recipients of lung grafts. In our experience, bacterial infections are the most common (two of three infections), but have the lowest mortality. Efforts should be directed toward establishing effective prophylaxis programs and early detection of infection. (Chest 1992; 101:1056-59), Isolated lung and heart-lung transplantation have become accepted approaches to the treatment of end-stage pulmonary parenchymal and pulmonary vascular disease. Since early reports from major heart-lung transplant centers,[1,2] it has [...]

A 26-year-old man cured of childhood acute lymphoblastic leukemia underwent a single lung transplant for drug-induced pulmonary toxicity 9 years after the completion of chemotherapy. It is not known whether [...]

During a single week in April 1982, cultures for Mycobacterium tuberculosiswere reported positive from nine patients who did not appear clinically to have active infection. Each of the patients had only one positive culture out of multiple specimens cultured. At the time of investigation, five specimens were available and were found to be all of the same phage type which strongly suggested cross-contamination. Four patients received antituberculosis chemotherapy. In one year of follow-up of the five who did not receive chemotherapy, none developed clinical disease. the contamination was probably due to faulty laboratory technique, but the source of the contaminant is uncertain. This investigation suggests that patients without clinical evidence of active infection and with isolated positive cultures for Mycobacterium tuberculosisshould be carefully evaluated before they are subjected to a prolonged, potentially toxic, and expensive course of chemotherapy.

Twenty-four isolated double lung transplants (LTXs) have been performed in 22 patients with cystic fibrosis, with a follow-up of 4 to 47 months. Prior to LTX, all patients were colonized with Pseudomonas aeruginosa, and ten patients were also colonized with Pseudomonas cepacia. Both organisms were specifically sought before LTX. All patients who grew P cepaciabefore LTX did so after LTX. Five additional patients only grew this bacterium after LTX. There was no difference between those who grew P cepaciaand those who did not in terms of data before LTX for age, weight, pulmonary function, and 6-min walk. After LTX, 7 of the 15 patients who had ever grown P cepaciadied. No patient who grew only P aeruginosadied. The median survival in the subgroup with P cepaciawas 28 days. Five of the seven died as a direct result of P cepaciapneumonia and sepsis. One died of cyclosporin A (cyclosporine) neurotoxicity with concurrent P cepaciapneumonia, and one died at the time of a retransplant for graft failure (associated with three bouts of P cepaciapneumonia and cytomegalovirus). Four of seven had not grown this bacterium before LTX. There were no perioperative factors, including antibiotic choices, that distinguished survivors and nonsurvivors. Overall 1-year survival is about 70 percent (15/22). Fourteen bouts of P cepaciapneumonia occurred in 12 patients. Four empyemas, one lung abscess, one suppurative pericarditis, and five cases of sinusitis were also due to this bacterium. In conclusion, P cepaciais responsible for excess morbidity and mortality after LTX. This organism is particularly lethal if isolated for the first time after LTX. Factors predicting its acquisition in this setting are unknown. While it is possible that the facial sinuses may act as an unrecognized reservoir or that patients or equipment provide a source, further study into the epidemiology of this organism is necessary to improve the survival of colonized patients undergoing LTX.