Management of the transplant recipient with pulmonary infection.

Pneumonia is a common and potentially fatal complication of transplantation. The clinical approach to this problem requires a multipronged attack. Thorough evaluation of the donor and recipient reduces the risk of infection while pointing to likely infectious complications to be anticipated posttransplant. Careful attention to infection control measures with emphasis on handwashing, high efficiency particulate air filtration, and aggressive outbreak investigation minimizes nosocomial pneumonias. Appropriate use of vaccines and prophylactic antimicrobial therapies decreases posttransplant morbidity and mortality. Once pneumonia occurs, a rapid, thorough diagnostic evaluation increases the likelihood of survival for the individual patient and focuses attention on environmental risks that may pose a hazard to the other transplant recipients in the clinician's institution.