title: Long-term pulmonary infections in heart transplant recipients.
abstract: OBJECTIVE
  Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients.
  
  
  METHODS
  Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected.
  
  
  RESULTS
  In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis.
  
  
  CONCLUSIONS
  Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.
authors.affiliation: From the Departments of Pulmonary Diseases, Baskent University School of Medicine, Ankara, Turkey.
authors.forename: Elif
authors.initials: E
authors.lastname: Küpeli
authors.forename: Gaye
authors.initials: G
authors.lastname: Ulubay
authors.forename: Esma Sevil
authors.initials: ES
authors.lastname: Akkurt
authors.forename: Füsun
authors.initials: F
authors.lastname: Öner Eyüboğlu
authors.forename: Atilla
authors.initials: A
authors.lastname: Sezgin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001999:Bronchoscopy; D042241:Early Diagnosis; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D055744:Invasive Pulmonary Aspergillosis / Q000382:microbiology / Q000517:prevention & control; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000276:immunology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D011237:Predictive Value of Tests; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents