Chlamydia pneumoniae infection after lung transplantation.
BACKGROUND
Chlamydia pneumoniae is established as a common agent of acute respiratory tract infection and has been implicated in the pathogenesis of asthma and chronic obstructive pulmonary disease. Airway disease is a prominent cause of morbidity and mortality after lung transplantation. We investigated the role of C pneumoniae as a pulmonary pathogen after lung transplantation.


METHODS
Eighty lung transplant recipients underwent 232 bronchoscopies with bronchoalveolar lavage with or without transbronchial lung biopsy during 1 year for surveillance of rejection and infection, or where clinically indicated.


RESULTS
C pneumoniae was detected using nested polymerase chain reaction in 9 of 36 (25%) recipients studied within 30 days of lung transplantation, 3 of whom remained positive on repeat lavage and died from airway disease in the first year post-operatively. By comparison, all 27 recipients with negative lavage survived >1 year. Lavage was positive for C pneumoniae in 18 of 71 (25%) recipients studied >30 days after lung transplantation, 5 of whom had pneumonia and 8 of whom had bronchiolitis obliterans syndrome. Eleven also had acute pulmonary allograft rejection.


CONCLUSIONS
Persistent infection with C pneumoniae (whether donor-derived, de novo or re-activated) appears deleterious to pulmonary allograft function and is associated with early mortality, rejection and bronchiolitis obliterans syndrome after lung transplantation. A trial of empiric antibiotic therapy for C pneumoniae may therefore be warranted in the attempt to prevent progressive inflammatory airway disease.
Glanville
Allan R
AR
Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia. aglanville@stvincents.com.au
Gencay
Mesut
M
Tamm
Michael
M
Chhajed
Prashant
P
Plit
Marshall
M
Hopkins
Peter
P
Aboyoun
Christina
C
Roth
Michael
M
Malouf
Monique
M
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology*; D018893:Bronchoalveolar Lavage; D023521:Chlamydophila Infections / Q000209:etiology* / Q000401:mortality; D016993:Chlamydophila pneumoniae / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000401:mortality; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome