Multiorgan Transplant Infectious Diseases Division, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Infect Dis. 2010 Dec;23(6):578-83. doi: 10.1097/QCO.0b013e32833f9f93.
Infections are major causes of morbidity and mortality after lung transplantation. Pretransplant evaluation can identify patients at risk of infectious complications and guide prophylactic strategies post transplantation. This review focuses on studies published from 2006 to the present that relate to the assessment of risk of infection prior to lung transplantation.
Pretransplant airways colonization with Pseudomonas, Burkholderia, nontuberculosis mycobacteria, Aspergillus and Scedosporium tend to recur after transplantation and cause disease in the lung allograft. Recently, colonization with Pseudomonas and Aspergillus species has been implicated in the subsequent development of allograft dysfunction. B. cenocepacia and Mycobacterium abscessus are particularly associated with poor outcomes after lung transplantation and are considered to be relative contra-indications to lung transplantation in many centers. Tuberculin skin test (TST) has limited value in predicting tuberculosis (TB) reactivation; however, in the absence of a better test, it remains the gold standard for screening patients with latent TB. Serologic screening for histoplasmosis and toxoplasmosis has limited value as these infections rarely occur after lung transplantation.
Recurrence of pretransplant airway infection and reactivation of latent infection are potential sources of infection after lung transplantation. Prospective studies are needed to determine the efficacy of prophylactic antimicrobial strategies.
感染是肺移植后发病率和死亡率的主要原因。移植前评估可以识别出有感染并发症风险的患者，并指导移植后的预防策略。本综述重点关注 2006 年至今发表的与肺移植前感染风险评估相关的研究。
移植前气道假单胞菌、伯克霍尔德菌、非结核分枝杆菌、曲霉属和枝孢霉属的定植往往在移植后复发，并导致肺移植物发生疾病。最近，假单胞菌和曲霉属的定植与移植物功能障碍的后续发展有关。洋葱伯克霍尔德菌和脓肿分枝杆菌与肺移植后不良预后特别相关，在许多中心被认为是肺移植的相对禁忌证。结核菌素皮肤试验（TST）在预测结核病（TB）再激活方面的价值有限；然而，在没有更好的检测方法的情况下，它仍然是筛查潜伏性 TB 患者的金标准。对组织胞浆菌病和弓形体病的血清学筛查价值有限，因为这些感染在肺移植后很少发生。
移植前气道感染的复发和潜伏感染的再激活是肺移植后感染的潜在来源。需要前瞻性研究来确定预防性抗菌策略的疗效。
