Diagnosis and treatment of pulmonary cavity after liver transplantation.

BACKGROUND

Although the outcomes have improved in the current era, pulmonary infection remains a significant post-transplant complication in liver transplant (LT) recipients. Pulmonary infection with cavity formation often leads to higher mortality rates after LT. We wished to investigate the diagnosis and treatment of pulmonary cavity (PC) formation after LT.

METHODS

We evaluated (retrospectively) five cases of PC formation, shown on CT scans of the chest after LT, by analyzing imaging features, diagnosis, treatment, liver function, and the concentration changes and efficacy of immunosuppressants.

RESULTS

According to the results from the CT scan, serum galactomannan (GM) assay, the purified protein derivative (PPD) skin test, and the sputum smears and blood culture, three cases were diagnosed with infection, and the other two cases were diagnosed with infection. Liver function and FK506 concentration were monitored during treatment. Antibiotics used for treatment of and infections affected liver function and FK506 concentration. However, after adjustment of drug doses, antibiotic treatment was tolerated in all patients. Four cases were cured, but 1 patient died of infection.

CONCLUSIONS

Distinguishing between infection and infection for PCs after liver transplantation (LT) using a CT scan is difficult. The diagnosis can be confirmed using clinical characteristics, sputum culture, GM assay, PPD, and sputum smears. Early diagnosis and treatment could lead to a better prognosis.