Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Department of Medicine, Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida; Miami Transplant Institute, Jackson Health System, Miami, Florida.
Transplant Proc. 2023 Mar;55(2):466-469. doi: 10.1016/j.transproceed.2023.02.001. Epub 2023 Feb 25.
Pulmonary nodules in asymptomatic patients could represent latent pulmonary infections. Intestinal transplant (ITx) recipients with preexisting lung nodules might be at higher risk for pulmonary infections. However, data is scarce.
This retrospective study included adult patients who underwent ITx from May 2016 to May 2020. Chest computed tomography scans performed within 12 months before ITx were obtained to evaluate for preexisting pulmonary nodules. Screening for endemic mycoses, Aspergillus, Cryptococcus, and latent tuberculosis infection performed within 12 months before ITx was obtained. We assessed for worsening pulmonary nodules, and fungal and mycobacterial infections during the first year post-transplant. Survival and graft loss at 1-year post-transplant was also assessed.
Forty-four patients underwent ITx. Thirty-one had preexisting lung nodules. No invasive fungi were recorded in the pretransplant period and one individual had latent tuberculosis infection. In the post-transplant period, one individual developed probable invasive aspergillosis and had worsening nodular opacities, whereas one had disseminated histoplasmosis with stable lung nodules in chest computed tomography. No mycobacterial infections were documented. The cohort survival was 84% at 12 months after transplant.
Preexisting pulmonary nodules were common in the cohort (71%), yet latent and active pulmonary infections were rare. Appearance of new or worsening pulmonary nodules does not appear to directly correlate with pulmonary infections in the post-transplant period. Routine chest computed tomography is not recommended in the pretransplant period, but follow-up is favored in patients with confirmed nodular opacities. Clinical monitoring is essential.
无症状患者的肺部结节可能代表潜在的肺部感染。有肺部结节的肠移植（ITx）受者可能有更高的肺部感染风险。然而，相关数据有限。
本回顾性研究纳入了 2016 年 5 月至 2020 年 5 月期间接受 ITx 的成年患者。获取 ITx 前 12 个月内进行的胸部计算机断层扫描（CT）以评估是否存在预先存在的肺部结节。获取 ITx 前 12 个月内进行了针对地方性真菌病、曲霉菌、隐球菌和潜伏性结核感染的筛查。我们评估了移植后 1 年内肺部结节的恶化情况，以及真菌感染和分枝杆菌感染情况。还评估了移植后 1 年的生存率和移植物丢失率。
44 例患者接受了 ITx。31 例患者存在预先存在的肺部结节。在移植前期间未记录到侵袭性真菌，有 1 例患者存在潜伏性结核感染。在移植后期间，1 例患者发生了疑似侵袭性曲霉病，出现结节性混浊加重，1 例患者发生了播散性组织胞浆菌病，胸部 CT 显示肺部结节稳定。未发现分枝杆菌感染。移植后 12 个月时，患者总体生存率为 84%。
预先存在的肺部结节在本队列中很常见（71%），但潜伏性和活动性肺部感染罕见。新出现或恶化的肺部结节的出现似乎与移植后期间的肺部感染没有直接关联。不建议在移植前期间进行常规胸部 CT，但建议对已确诊的结节混浊患者进行随访。临床监测至关重要。
