title: Single lung transplantation. Factors in postoperative cytomegalovirus infection.
abstract: Thirty-one single lung transplantations were performed between March 17, 1988, and November 1, 1990. Postoperative infection, especially with cytomegalovirus, has been the major cause of morbidity and mortality. Eighteen of the 31 patients were receiving prednisone before transplantation. Every patient was prepared preoperatively with oral cyclosporine 5 mg/kg and azathioprine (Imuran) 2 mg/kg. Every patient received methylprednisolone for 3 days postoperatively, followed by prednisone 1.0 mg/kg/day, oral cyclosporine, and azathioprine. Ten patients additionally had cytolytic therapy with OKT3 and 12 with antilymphocyte globulin. Nine patients had no cytolytic therapy. Cytolytic therapy was chronologic, not randomized. Postoperative infection occurred in 20 patients, 13 of whom had cytomegalovirus infection. Preoperative use of prednisone did not correlate with postoperative infection, cytomegalovirus, or death. Postoperative infection occurred in 17 of 22 patients with cytolytic therapy compared with three of nine without cytolytic therapy (p = 0.035). Cytomegalovirus infection occurred in 13 of 22 with cytolytic therapy and in none of the nine without cytolytic agents (p = 0.003). Therefore preoperative prednisone does not appear to be a contraindication to single lung transplantation. Cytolytic therapy with either OKT3 or antilymphocyte globulin increases the prevalence of postoperative infection with cytomegalovirus and should not be used in patients undergoing lung transplantation.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, San Antonio.
authors.forename: J H
authors.initials: JH
authors.lastname: Calhoon
authors.forename: L
authors.initials: L
authors.lastname: Nichols
authors.forename: R
authors.initials: R
authors.lastname: Davis
authors.forename: C L
authors.initials: CL
authors.lastname: Bryant
authors.forename: S M
authors.initials: SM
authors.lastname: Levine
authors.forename: C A
authors.initials: CA
authors.lastname: Zamora
authors.forename: A
authors.initials: A
authors.lastname: Anzueta
authors.forename: C T
authors.initials: CT
authors.lastname: Lum
authors.forename: F L
authors.initials: FL
authors.lastname: Grover
authors.forename: J K
authors.initials: JK
authors.lastname: Trinkle
mesh_terms: D000075202:Contraindications; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use; D011292:Premedication; D015995:Prevalence
chemical_list: D007166:Immunosuppressive Agents; D011241:Prednisone