Overview

Pneumonia is a very common complication of lung transplantation, with an overall prevalence of 60% in lung recipients. The heightened susceptibility to lung infection stems from several factors related to the allograft such as impaired cough reflex of the lung allograft, poor mucociliary clearance, ischemia to the explanted lung, abnormal lymphatic drainage, diffuse reperfusion injury, and airway inflammation caused by rejection and resulting in bacterial colonization. After single lung transplantation, the allograft may become infected from the remaining native lung. Gram-negative bacteria, including the Enterobacteriaceae and P. aeruginosa, account for the majority of post-transplant pneumonias. Other important pathogens are S. aureus, H. influenzae, and Streptococcus pneumoniae. B. cepacia colonization is associated with high morbidity and mortality after transplantation for cystic fibrosis.

Mediastinitis and sternal wound infections are other important post-operative infections in lung transplant recipients. The most serious complications after lung transplantation are leakage or dehiscence of the bronchial or tracheal anastomosis.

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