Prevention and Management of Infections in Lung Transplant Recipients
Abstract
:1. Risk of Infection and the Timeline of Predisposition to Infection
2. Bacterial Infection in LTRs
3. Pre-Lung Transplant
4. 0–1 Month Post LTR
5. 1–6 Months and after 6 Months Post LT
6. Viral Infections in LTR
7. Pre-LT Recipient and Pre-LT Donor Screening
8. Fungal Infections in LTRs
9. Pre-LT
10. Post-LT
11. Parasitic Infections in LTR
12. Future Directions in Lung Transplantation
13. Conclusions
Funding
Conflicts of Interest
References
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Bacteria | Blood Culture |
Sputum Culture | |
Vital | Hepatitis C Virus Nuclear Antigen Amplification |
Human Immune Deficiency Virus (HIV) Nuclear Antigen Amplification | |
4th generation HIV | |
Hepatitis B Core Antibody | |
Hepatitis B Surface Antigen and Antibody | |
Hepatitis B Nuclear Antigen Amplification | |
Human T Lymphotropic Virus Nuclear Antigen Amplification and I/II Antibody | |
Cytomegalovirus Serology IgG | |
Epstein–Barr Virus (VCA) (IgG) | |
Ebstein–Barr Virus (VCA) (IgM) | |
Epstein–Barr Virus Nuclear Antigen | |
West Nile Nuclear Antigen Amplification | |
Nasopharyngeal Swab for SARS COVID-19 | |
Fungal | Sputum Culture |
Parasite | Toxoplasma (IgG) |
Chagas NAT | |
Strongyloidiasis Serology |
Timeline of Common Post-Transplant Infections | |||
---|---|---|---|
Source | <4 weeks | 1–12 months | >12 months |
Nosocomial, related to surgery, donor or recipient-derived | Activation of latent infections, opportunistic infections | Community-derived infections | |
Bacteria | Bacterial infections are due to the following scenarios. Anastomotic leak, Clostridium dificille, line infection, wound infections, nosocomial pneumonia, urinary tract infections | Listeria, Nocardia, Mycobacterium | Community-derived infections |
Viruses | Donor-derived viruses | Herpes group (CMV, EBV, HHV6, 8, HSV, VZV), Hepatitis viruses (HAV, HBV, HCV, HEV), Retroviruses (HIV, HTLV-1 and 2) | Community-acquired viruses, CMV, HPV, JC Polyoma Virus, PTLD |
Fungi | Candida species | Aspergillus, endemic fungi, Mucor, Scedosporium, PCP | Aspergillus, Mucor, Scedosporium, Cryptococcus |
Parasites | Less likely | Leishmania, Toxoplasma gondii, Trypanosoma Cruzii, Strongyloides stercoralis | Strongyloides stercoralis |
Screening for Viruses |
---|
Human immunodeficiency virus serology (ELISA) or fourth-generation ELISA |
Hepatitis B (HBV) serologies including HBV surface antigen (or HepB NAT), core antibody, surface antibody, QNAT if + |
Hepatitis C antibody, QNAT if + |
Cytomegalovirus antibody |
Epstein–Barr virus (EBV) antibody panel (EBV viral capsid antigen, +/− early antigen, and nuclear antigen antibody levels) |
Measles, mumps, rubella serologies |
CMV Serologic Status | Risk for Reactivation | Possible Regimen | Suggested Duration of Follow-Up |
---|---|---|---|
D+/R− | High Risk | >12 months of prophylaxis with valganciclovir | Monthly for 6 months after discontinuation of therapy |
D+/R− | High Risk | >12 months of prophylaxis with valganciclovir | Monthly for 6 months after discontinuation of therapy |
R+ | Intermediate Risk | 6–12 months | For symptoms (may monitor monthly for 3–6 months after therapy) |
R+ | Intermediate Risk | 6–12 months | For symptoms (may monitor monthly for 3–6 months after therapy) |
D−/R− | Low Risk | Targeting HSV/VZV with Acyclovir | Symptoms follow-up |
Indications for Hepatitis B Treatment in Lung Transplant Recipient | |
---|---|
HbsAg-positive recipient | HBIG + oral antiviral therapy |
Anti-HBc-positive/Anti-HBs-negative recipients | Oral antiviral therapy |
Anti-HBc-negative/Anti-HBs-positive recipient | Oral antiviral therapy |
Most Common Fungal Pathogens in Lung Transplant Patients |
---|
Aspergillus |
Invasive candidiasis |
Cryptococcus |
Pneumocystis jirovecii pneumonia |
Scedosporium spp. |
Fusarium |
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Fayyaz, A.; Raja, M.; Natori, Y. Prevention and Management of Infections in Lung Transplant Recipients. J. Clin. Med. 2024, 13, 11. https://doi.org/10.3390/jcm13010011
Fayyaz A, Raja M, Natori Y. Prevention and Management of Infections in Lung Transplant Recipients. Journal of Clinical Medicine. 2024; 13(1):11. https://doi.org/10.3390/jcm13010011
Chicago/Turabian StyleFayyaz, Anum, Mohammed Raja, and Yoichiro Natori. 2024. "Prevention and Management of Infections in Lung Transplant Recipients" Journal of Clinical Medicine 13, no. 1: 11. https://doi.org/10.3390/jcm13010011
APA StyleFayyaz, A., Raja, M., & Natori, Y. (2024). Prevention and Management of Infections in Lung Transplant Recipients. Journal of Clinical Medicine, 13(1), 11. https://doi.org/10.3390/jcm13010011