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Eighteen serious pulmonary infections have been encountered in 10 of 16 surviving cardiac transplant recipients. Fourteen of 18 infections (78%) occurred within the first six months after transplant and the remaining 4 (22%) after the first six months (p less than 0.05). There was no correlation between the number of rejections per patient and propensity toward infection. Transtracheal aspiration or percutaneous lung aspiration established the diagnosis in all but two episodes. Percutaneous lung aspiration appeared more accurate as a diagnostic tool but was associated with 6 complications in 13 attempts (46%), while no complications occurred in 17 attempts with transtracheal aspiration (p less than 0.05). Five of the 10 patients had multiple episodes of pulmonary infection; 2 of these 5 (40%) had concurrent infections. Nocardia organisms were encountered most frequently, accounting for 7 of 18 (39%) infections; 6 of 10 patients (60%) were infected with Nocardia at some point after transplant. Nine of 10 patients (90%) were cured of infection. Eight are still alive without evidence of infection. We conclude from these data that pulmonary infection is common in transplant recipients, that early definitive diagnosis, in spite of the potential complications, is warranted, and that cure of infection and long-term survival are possible if treatment is timely and aggressive.

Minocycline hydrochloride was used to treat pulmonary infections with Nocardia asteroides in five cardiac allograft recipients. In three patients, minocycline was successfully used as the only antinocardial agent. Two other patients were found to have leukopenia after initial therapy with sulfisoxazole. These two patients were subsequently treated with minocycline. The clinical success with minocycline in these highly immunosuppressed patients suggests that minocycline is an effective antinocardial agent. These data did not allow any conclusion regarding which drug, minocycline or sulfisoxazole, is superior in the treatment of this disease.