Prevention and Treatment Regimens for Non-viral Infections in the Lung Transplant Recipient

Lung transplantation has become an accepted treatment for patients with end-stage pulmonary parenchymal and vascular disease. Despite more than two decades of improvements in surgical technique and immunosuppressive agents, long-term survival of the lung transplant recipient continues to lag behind other solid organ transplants. Infection remains the leading cause of morbidity and mortality at all time points following lung transplantation. Challenges in managing infections in the lung transplant recipient include (1) difficulty in the recognition of and early diagnosis of infection as infectious signs and symptoms may be masked by immunosuppressive agents; (2) acute cellular rejection that may present as a febrile illness with chest radiographic changes in the lung transplant recipient; (3) significant drug-drug interactions between anti-infectious agents and immunosuppressive medications and their toxic side effects; (4) a broad array of pathogens causing clinical disease; and (5) the rapid progression of infections. Invasive diagnostic tests are typically required to make a timely diagnosis which is essential to optimize treatment and limit adverse side effects and immunosuppressive drug interactions. This chapter will review the prevention, diagnosis, and treatment of common non-viral infections in lung transplant recipients.