Fayyaz Anum, Raja Mohammed, Natori Yoichiro
Miami Transplant Institute, Jackson Health System, Division of Infectious Disease, Department of Clinical Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Clin Med. 2023 Dec 19;13(1):11. doi: 10.3390/jcm13010011.
Anti-rejection medications are essential in preventing organ rejection amongst solid organ transplant recipients; however, these agents also cause profound immunosuppression, predisposing lung transplant recipients (LTRs) to infectious complications. The timely management including prevention, diagnosis, and treatment of such infectious complications is vital to prevent significant morbidity and mortality in solid organ transplant recipients and allograft dysfunction. LTRs are inundated with microbes that may be recognized as commensals in hosts with intact immune systems. Bacterial infections are the most common ones, followed by viral pathogens. Indications of a brewing infectious process may be subtle. Hence, the importance of adapting vigilance around isolated hints through symptomatology and signs is pivotal. Signals to suggest an infectious process, such as fever and leukocytosis, may be dampened by immunosuppressive agents. One must also be vigilant about drug interactions of antibiotics and immunosuppressive agents. Treatment of infections can become challenging, as antimicrobials can interact with immunosuppressive agents, and antimicrobial resistance can surge under antimicrobial pressure. Transplant infectious disease physicians work in concert with transplant teams to obtain specimens for diagnostic testing and follow through with source control when possible. This heavily impacts medical decisions and fosters a multidisciplinary approach in management. Furthermore, the reduction of immunosuppression, although it augments the risk of allograft rejection, is as crucial as the initiation of appropriate antimicrobials when it comes to the management of infections.
抗排斥药物对于预防实体器官移植受者的器官排斥至关重要；然而，这些药物也会导致严重的免疫抑制，使肺移植受者（LTRs）易发生感染性并发症。及时管理，包括预防、诊断和治疗此类感染性并发症，对于预防实体器官移植受者的严重发病和死亡以及同种异体移植功能障碍至关重要。LTRs接触到的微生物在免疫系统完整的宿主中可能被视为共生菌。细菌感染是最常见的，其次是病毒病原体。正在形成的感染过程的迹象可能很微妙。因此，通过症状和体征对孤立线索保持警惕至关重要。提示感染过程的信号，如发热和白细胞增多，可能会被免疫抑制剂抑制。还必须警惕抗生素与免疫抑制剂的药物相互作用。感染的治疗可能会变得具有挑战性，因为抗菌药物可能与免疫抑制剂相互作用，并且在抗菌压力下抗菌耐药性可能会激增。移植传染病医生与移植团队协同工作，获取标本进行诊断测试，并在可能的情况下进行源头控制。这对医疗决策有重大影响，并促进了多学科管理方法。此外，减少免疫抑制虽然会增加同种异体移植排斥的风险，但在感染管理方面与开始使用适当的抗菌药物一样至关重要。
