ABSTRACT
It has been almost a quarter century since the first successful heart-lung transplant operation was carried out at Stanford University in 1981. In the intervening years, heart-lung and lung transplantation have become an accepted treatment for patients with end-stage lung disease. Overall clinical results in lung and heart-lung transplantation, however, still lag behind other types of transplantation. For instance, the recent three-year survival for lung transplant recipients in the United States is about 20% worse than the survival for liver or heart transplant recipients (1). There are many reasons for this reduced survival, but a significant role is undoubtedly played by the high infection rate in lung transplant recipients (2-6). It has been shown that heart-lung recipients have nearly twice the rate of infection as heart recipients managed by the same physicians (2). Most deaths after lung transplantation are associated with infection, either as a primary or as a secondary event (3). This chapter discusses bacterial infections and pneumocystis infections after lung transplantation. Bacterial pathogens are the most common infections after lung transplantation and pose the greatest infectious risk to lung recipients, particularly within the first few months after transplantation. Pneumocystis infections were common in the early days of lung transplantation but have almost totally
disappeared now due to universal use of effective prophylaxis. Nonetheless, lung recipients must still be considered to be highly susceptible to pneumocystis infections and effective prophylaxis remains an important component of lung transplant management.
