Assessment of infection risks prior to lung transplantation.
OBJECTIVE
Infections are major causes of morbidity and mortality after lung transplantation. Pretransplant evaluation can identify patients at risk of infectious complications and guide prophylactic strategies post transplantation. This review focuses on studies published from 2006 to the present that relate to the assessment of risk of infection prior to lung transplantation.


RESULTS
Pretransplant airways colonization with Pseudomonas, Burkholderia, nontuberculosis mycobacteria, Aspergillus and Scedosporium tend to recur after transplantation and cause disease in the lung allograft. Recently, colonization with Pseudomonas and Aspergillus species has been implicated in the subsequent development of allograft dysfunction. B. cenocepacia and Mycobacterium abscessus are particularly associated with poor outcomes after lung transplantation and are considered to be relative contra-indications to lung transplantation in many centers. Tuberculin skin test (TST) has limited value in predicting tuberculosis (TB) reactivation; however, in the absence of a better test, it remains the gold standard for screening patients with latent TB. Serologic screening for histoplasmosis and toxoplasmosis has limited value as these infections rarely occur after lung transplantation.


CONCLUSIONS
Recurrence of pretransplant airway infection and reactivation of latent infection are potential sources of infection after lung transplantation. Prospective studies are needed to determine the efficacy of prophylactic antimicrobial strategies.
Luong
Me-Linh
ML
Multiorgan Transplant Infectious Diseases Division, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Morrissey
Orla
O
Husain
Shahid
S
D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016040:Lung Transplantation; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D057234:Preoperative Period; D012008:Recurrence; D012137:Respiratory System / Q000382:microbiology; D018570:Risk Assessment