Parada M T, Alba A, Sepúlveda C
Clinica Las Condes, Santiago, Chile.
Transplant Proc. 2010 Jan-Feb;42(1):333-5. doi: 10.1016/j.transproceed.2009.12.002.
Infections are an important cause of morbidity and mortality among transplanted patients. Their pathophysiology is associated with anatomic factors, immunosuppression, and pretransplant viral exposure. The aim of this investigation was to characterize infections following lung transplantation. We retrospectively analyzed the charts of 51 lung transplant recipients, who were transplanted between 1999 and 2008. Infections were classified according to their origin, etiology, occurrence time, and risk factors. The patient mean age was 55 years (range 13-71), 65% were male, and pulmonary fibrosis was the lung disease etiology in 59% of cases. Seventy-one episodes of infection were reported in the 51 patients, including (75%) during the first year after transplantation and 30 within the first 3 months (42%). Between the 4th and 11th months the number of infections decreased to 23 (32%), and afterwards there were 18 additional cases. The original site of infection was pulmonary in 43 episodes (60%), and the etiology was bacterial in 34 (48%), with Pseudomonas in 12 instances (35% of bacterial infections). Viruses were involved in 25 episodes, especially cytomegalovirus (CMV) in seronegative patients. The nine infections of fungal etiology (13%) were all caused by Aspergillus and always associated with either an acute rejection episode or suture damage. Three cases of tuberculosis were diagnosed, including two in the late post-transplant period. Three patients died of early infections.
The critical period for infections in lung transplantation patients is the first 3 months, especially for those of bacterial etiology. CMV diseases were more common in seronegative patients and fungal infections in airway injury cases.
感染是移植患者发病和死亡的重要原因。其病理生理学与解剖因素、免疫抑制及移植前病毒暴露有关。本研究的目的是描述肺移植后的感染情况。我们回顾性分析了1999年至2008年间接受肺移植的51例患者的病历。根据感染的来源、病因、发生时间和危险因素对感染进行分类。患者平均年龄为55岁（范围13 - 71岁），65%为男性，59%的病例肺部疾病病因是肺纤维化。51例患者共报告71次感染发作，其中75%发生在移植后第一年，30次发生在头3个月内（42%）。在第4至11个月期间，感染次数降至23次（32%），之后又有18例。43次感染的原发部位在肺部（60%），病因是细菌的有34次（48%），其中铜绿假单胞菌12例（占细菌感染的35%）。病毒感染涉及25次发作，血清阴性患者中尤其以巨细胞病毒（CMV）感染为主。9次真菌感染（13%）均由曲霉菌引起，且总是与急性排斥反应发作或缝线损伤相关。诊断出3例结核病，其中2例发生在移植后期。3例患者死于早期感染。
肺移植患者感染的关键时期是头3个月，尤其是细菌感染病因的患者。CMV疾病在血清阴性患者中更常见，真菌感染在气道损伤病例中更常见。
