Infection prophylaxis in lung transplantation

Zusammenfassung

Heart-lung and lung transplantation became therapeutic options for end-stage pulmonary diseases due to improved surgical technique, perioperative management and the availability of potent immunosuppressive agents. Successful therapy and control of acute rejection episodes is counterbalanced by an increase in infectious complications. The first few months after transplantation remain a very sensitive period for infections due to the surgical procedure, intensive immunosuppression, reactivation of latent viral infections and transmission of microorganisms from donors [5]. Furthermore after lung transplantation the same organ is the target for rejection and infection. Therefore pulmonary infections are frequent in lung transplant recipients. Despite the limited therapeutic response to immunosuppressive agents, chronic rejection is usually treated with enhanced immunosuppression followed by a higher risk of infectious complications (Table 1). The organic changes in bronchiolitis obliterans decrease bronchiolar mucous clearance and further facilitate bacterial and fungal infection. To adequately treat infectious complications after transplantation, aggressive diagnostic approaches are needed. In recent years it also became clear that transplant associated malignancies are most often triggered by viral infections. Prophylactic strategies (Table 2) against infections have to consider the time after transplantation, the specific risk of different patient groups and the intensity of immunosuppression including antirejection treatment. The manner of drug administration and the overall costs have also to be considered. In viral infections, prophylactic strategies have partly been replaced by pre-emptive treatment approches further specifying the patients at highest risk to develop diseases (Table 3). Another approach to prevent infection in some patient groups is to match the recipients to the serostatus of the donors.