Complications In Lung Transplant Recipients Research Articles

Thoracoscopic Decortication for Tubercular Empyema in a Lung Transplant Recipient

Tubercular empyema thoracis is a morbid postoperative complication in lung transplant recipients, which significantly impairs graft function and affects the survival rate. This report describes a case of tubercular empyema thoracis in a 42-year-old female, who underwent bilateral sequential lung transplantation for interstitial lung disease (non-specific interstitial pneumonia). She underwent video-assisted thoracoscopic surgery decortication, a preferred surgical approach due to its minimally invasive nature with excellent success rates. This report highlights the effectiveness of tailored surgical interventions and the importance of individualized post-transplant care to optimize patient recovery and graft functionality.

Custom silicone Y-stents for the management of anastomotic stenosis in lung transplant recipients

BackgroundAirway stenting may be needed to manage anastomotic complications in lung transplant recipients. Conventional stenting strategies may be inadequate due to anatomic variations between the recipient and donor or involvement of both the anastomosis and lobar bronchi. MethodsWe investigated the efficacy of 3D-designed patient-specific silicone Y-stents in managing this scenario. 9 patients with complex airway stenosis underwent custom stent insertion after either failing traditional management strategies or having anatomy not suitable for conventional stents. CT images were uploaded to stent design software to make a virtual stent model. 3D printing technology was then used to make a mold for the final silicone stent which was implanted via rigid bronchoscopy. Forced expiratory volume in 1 s (FEV1) was measured pre- and post-stent placement. Results78 % of patients experienced an increase in their FEV1 after stent insertion, (p = 0.001, 0.02 at 30 and 90 days respectively). Unplanned bronchoscopies primarily occurred due to mucous plugging. 2 patients had sufficient airway remodeling allowing for stent removal. ConclusionsPersonalized 3D-designed Y-stents demonstrate promising results for managing complicated airway stenosis, offering improved lung function and potential long-term benefits for lung transplant recipients.

Gastrointestinal complications in pediatric lung transplant recipients: Incidence, risk factors, and effects on patient outcomes.

Gastrointestinal (GI) complications in lung transplant recipients can occur any time during the post-operative period, leading to prolonged morbidity and mortality. Despite the negative association between GI complications and patient outcomes, little is known about their incidence and risk factors for their development in pediatric lung transplant recipients. We performed a retrospective chart review at one pediatric tertiary center to describe the frequency of GI complications in lung transplant recipients. We identified potential risk factors for the diagnosis of gastroparesis, gastroesophageal reflux disease (GERD) and aspiration in the post-transplant period. Lastly, we investigated the association of these complications with mortality and graft survival. 84.3% of lung transplant recipients experienced at least one GI complication in the post-transplant period. Gastroparesis (52.9%), GERD (41.2%), and oropharyngeal dysphagia/laryngeal penetration (33.3%) were the most common complications diagnosed. Post-operative opioid exposure was a risk factor for gastroparesis, with the odds increasing 3.0% each day a patient was prescribed opioids (p = .021). The risk of death or retransplant in individuals who experienced gastroparesis was 2.7 times higher than those not diagnosed with gastroparesis (p = .027). Exposure to opioids in the post-operative period is a risk factor for gastroparesis and a prolonged hospitalization placed patients at risk for aspiration. Gastroparesis was associated with increased patient mortality and graft failure, while aspiration and GERD had no effect on long term outcomes. Future prospective studies investigating the relationship between opioid use and the development of a gastroparesis are necessary to improve patient outcomes.

Special Considerations and Techniques of Interventions in Lung Transplant Recipients

Lung transplant remains an important treatment option for patients with end-stage lung diseases providing improvement in survival rates and quality of life. Specialized considerations should be applied with interventions of lung transplant recipients as they host specific anatomic variations and high risk towards certain complications. In this article, we highlight the role of interventional radiology for lung transplant recipients along with discussion of interventional techniques. Specific emphasis is placed on describing and explaining the techniques pertained to the points of anastomosis, diagnosis and treatment of malignancies, and management of complications in lung transplant recipients.

Incidence of Acute Cellular Rejection After Granulocyte Colony-Stimulating Factor in Lung Transplant Recipients

Background Neutropenia is a common complication in lung transplant recipients (LTRs). Filgrastim may be used to treat neutropenia in LTRs, but its consequences on acute cellular rejection (ACR) remain controversial. Objective: The purpose was to examine the association between filgrastim and incidence of ACR 6 months after filgrastim administration in LTRs. Secondary outcomes included burden of ACR, infections, chronic lung allograft dysfunction (CLAD), and survival. Methods: This was a matched cohort study of patients transplanted between January 2010 and October 2019. LTRs who received filgrastim for neutropenia were compared to a cohort who did not. LTRs were matched on transplant indication, sex, age, and time post-transplant and multivariable logistic regression models were used to evaluate the likelihood of ACR. Results: 212 patients were included in the analysis (106 in each group). 50 patients (47.2%) in the filgrastim group experienced ACR compared to 37 patients (34.9%) in the no filgrastim group (P = .070). In multivariable analysis, filgrastim use was not associated with ACR at 6 months (OR 1.409, 95% CI 0.772-2.571). Time to first ACR was shorter (P = .049) and 6-month ACR score was higher in the filgrastim group (.49 vs .33, P = .047). LTRs in the filgrastim group had higher incidence of bacterial pneumonia and 1-year mortality. Conclusions: Although not associated with increased likelihood of ACR at 6 months, our study found that filgrastim is associated with increased ACR burden and decreased time to ACR. This study can help inform clinicians of ACR risk after filgrastim use in LTRs.

Risk factors and prognosis of airway complications in lung transplant recipients: A systematic review and meta-analysis

Airway complications (AC) are one of leading causes of morbidity and mortality after lung transplant (LTx), but their predictors and outcomes remain controversial. This study aimed to identify potential risk factors and prognosis of AC . A systematic review was performed by searching PubMed, Embase, and Cochrane Library. All observational studies reporting outcome and potential factors of AC after LTx were included. The incidence, mortality, and estimated effect of each factor for AC were pooled by using the fixed-effects model or random-effects model. Thirty-eight eligible studies with 52,116 patients undergoing LTx were included for meta-analysis. The pooled incidence of AC was 12.4% (95%Cl: 9.5-15.8) and the mean time of occurrence was 95.6 days. AC-related mortality rates at 30-days, 90-days, 6 months, 1 year, and 5 years were 6.7%, 17.9%, 18.2%, 23.6%, and 66.0%, respectively. Airway dehiscence was the most severe type with a high mortality at 30 days (60.9%, 95%Cl: 20.6-95.2). We found that AC was associated with a higher risk of mortality in LTx recipients (hazard ratio [HR] 1.71, 95%Cl 1.04-2.81). Eleven significant predictors for AC were also identified, including male donor, male recipient, diagnosis of COPD, hospitalization, early rejection, postoperative infection, extracorporeal membrane oxygenation, mechanical ventilation, telescopic anastomosis, and bilateral and right-sided LTx. AC was significantly associated with higher mortality after LTx, especially for dehiscence. Targeted prophylaxis for modifiable factors and enhanced early bronchoscopy surveillance after LTx may improve the disease burden of AC.

Complications of lung transplantation on computed tomography: pictorial essay.

Lung transplantation is becoming increasingly more common as an alternative treatment for end-stage lung disease. Despite advances in laboratory testing, surgical technique, and donor/recipient selection, lung transplantation is still associated with significant mortality, due to postoperative complications. This paper consists of a brief review of postoperative complications in lung transplant recipients, illustrating those complications with computed tomography images.

COVID-19 IN LUNG TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

COVID-19 IN LUNG TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

Antiphospholipid Antibodies and Outcomes Following Lung Transplantation

<h3>Purpose</h3> Pre-transplant antiphospholipid antibodies (aPLab), including anticardiolipin (aCL) and anti-B2 glycoprotein-I (aB2GPI), may be associated with thrombotic complications and graft loss in kidney and liver transplant recipients. The objective of this study was to evaluate the prevalence and impact of aPLab on post-operative thrombotic and bleeding complications in lung transplant recipients. <h3>Methods</h3> This was a single center retrospective cohort study of patients who were evaluated and transplanted between 1/1/2018-11/30/20. All candidates were screened for aPLab. We compared post-operative arterial and venous thrombotic events, treated as a combined endpoint, in recipients with and without aPLab (Fisher's exact test). Among recipients with aPLab, we recorded major bleeding events—defined as requiring blood transfusion or surgical exploration—while on therapeutic or prophylactic dose anticoagulation (AC). <h3>Results</h3> There were 100 patients who were evaluated and transplanted during the study period, 19 (19.0%) of whom had aPLab (Figure 1). Among these, 7 (36.8%) had pre-transplant deep vein thrombosis (DVT) or arterial thrombotic events. After transplant, 7 (36.8%) had new symptomatic DVT or arterial thromboses compared to 20 (24.7%) recipients without aPLab (p=0.39). Ten patients with aPLab were fully anticoagulated post-transplant, either because of prior or new thrombotic events. Of these, 6 (60.0%) had major bleeding. One aPLab patient had major bleeding on prophylactic AC. The majority (85.7%) of patients with major bleeding were on renal replacement therapy or had an eGFR <30. The one-year survival rate among recipients with aPLab was 89.5%. <h3>Conclusion</h3> The presence of a pre-transplant aPLab was not associated with an increase in new symptomatic DVT or arterial thrombotic events following lung transplant although the study was underpowered for small or moderate effects. The decision to anticoagulate patients with aPLab should account for other risk factors for bleeding including renal insufficiency.

Characterization of Letermovir Use and Pharmacokinetic Interaction with Immunosuppression in Lung Transplant Recipients

<h3>Purpose</h3> Cytomegalovirus (CMV) is a common complication in lung transplant recipients (LTRs). Traditional agents to treat and prevent CMV carry significant toxicities. Prior studies of the CMV-active antiviral letermovir have described pharmacokinetic interactions with immunosuppressive medications, but the LTR population has not routinely been included in these studies and clinical relevance remains unclear. <h3>Methods</h3> This single-center retrospective study included 16 LTRs transplanted between 12/1/2016-7/31/2020 initiated on letermovir while on calcineurin inhibitor and/or mTOR inhibitor-based immunosuppression. Dose-adjusted immunosuppression troughs (concentration/dose or C/D ratios) were collected at baseline and for 14 days after letermovir initiation. Descriptive statistics were used for baseline characteristics and select outcomes. Wilcoxon Sign Rank test was utilized for the primary outcome comparing C/D pre- and post- letermovir initiation. <h3>Results</h3> Patient characteristics are described in Table 1. The median C/D of all immunosuppressive agents were not significantly different after letermovir initiation (Table 2). Median time to resolution of leukopenia/neutropenia was 6 days and time to CMV viremia clearance in those treated was 45 days. <h3>Conclusion</h3> In this cohort of LTRs switched to letermovir for CMV prophylaxis or treatment, immunosuppression C/D ratios were not significantly different after conversion. Empiric dose adjustment is likely unnecessary for all LTRs; future studies should clarify the optimal use of letermovir in the SOT population.

Survival After Lung Transplantation in Europe - Clad as Major Cause of Death

<h3>Purpose</h3> Lung transplantation (LTX) outcomes are poor in comparison to other solid organ transplantations. Our aim was to review survival, leading chronic complications, and major causes of death in Europe. A particular focus is put on Chronic Lung Allograft Dysfunction (CLAD) and its trends. <h3>Methods</h3> There is no dedicated European registry on lung transplantation, outcomes, and complications. Therefore, accessible data from ISHLT registry with focus on the European continent, European Registries and German Quality report were screened for lung transplantation survival data. Furthermore, a dedicated literature research on chronic complications following LTX and particularly CLAD was performed with focus on Europe. In a further step, clinical trial registries were screened for advanced trials addressing the leading form of CLAD - obstructive phenotype - Bronchiolitis Obliterans Syndrome (CLAD-BOS). <h3>Results</h3> Survival rate for LTX reaches 83.2% and 71% at 1 and 3 years, based on 3502 cases included between 2013 and 2016 in the ISHLT registry - European Continent, under exclusion of retransplant. Eurotransplant data from 2012 to 2016 comprising 3053 LTX from Austria, Belgium, Germany, and the Netherlands state survival rates of 83.5%, 76.8% and 62.5% at year 1, 2 and 5. Yet, pan-European data are lacking. Some large monocentric European studies report CLAD rates ranging from 38% at 3 years to 44% at longer follow-up. These findings are in line with US data. CLAD-BOS represented consistently the most prevalent phenotype, up to 80% of all CLAD cases. Although no dedicated European registry data are available, monocentric studies pinpoint CLAD as the single largest cause of death post-LTX. Within CLAD, BOS phenotype accounts for two-thirds of deaths based on reported autopsy analysis. Currently, two substances targeting CLAD-BOS are in phase 3 clinical investigation in Europe. <h3>Conclusion</h3> In Europe, 3-year post-lung transplantation survival is around 70% and 5-year survival at 63%. CLAD is consistently the most prevalent and fatal complication in lung transplant recipients. CLAD-BOS is the most frequent phenotype. New treatments to address chronic graft failure and primary cause of death in LTX, namely CLAD-BOS, are needed. Currently two therapeutic approaches are under investigation in phase 3 clinical trials aiming at CLAD-BOS in Europe.

Airway complications in lung transplant recipients with telomere-related interstitial lung disease.

Patients with short telomere-related interstitial lung disease (ILD) have worse outcomes after lung transplantation. We hypothesized that post-transplant airway complications, including dehiscence and bronchial stenosis, would be more common in the short telomere ILD lung transplant population. We conducted a multi-institutional (Brigham and Women's Hospital, Groupe de Transplantation de la SPLF) retrospective cohort study of 63 recipients between 2009 and 2019 with ILD and short telomeres, compared to 4359 recipients from the Scientific Registry of Transplant Recipients with ILD and no known telomeropathy. In the short telomere cohort, six recipients (9.5%) developed dehiscence and nine recipients (14.3%) developed stenosis, compared to 60 (1.4%) and 149 (3.4%) in the control, respectively. After adjusting for age, sex, and bilaterality, the presence of short telomeres was associated with higher odds of dehiscence (odds ratio (OR)=8.24, 95% confidence interval (CI)=3.34 20.29, p<.001) and stenosis (OR=4.63, 95% CI 2.21 9.69, p<.001). The association between the presence of short telomeres and post-transplant dehiscence and stenosis suggest that airway complications may be a contributor to increased morbidity and mortality in patients with telomere-related ILD.

Viral infections in lung transplantation.

Viral infections account for up to 30% of all infectious complications in lung transplant recipients, remaining a significant cause of morbidity and even mortality. Impact of viral infections is not only due to the direct effects of viral replication, but also to immunologically-mediated lung injury that may lead to acute rejection and chronic lung allograft dysfunction. This has particularly been seen in infections caused by herpesviruses and respiratory viruses. The implementation of universal preventive measures against cytomegalovirus (CMV) and influenza (by means of antiviral prophylaxis and vaccination, respectively) and administration of early antiviral treatment have reduced the burden of these diseases and potentially their role in affecting allograft outcomes. New antivirals against CMV for prophylaxis and for treatment of antiviral-resistant CMV infection are currently being evaluated in transplant recipients, and may continue to improve the management of CMV in lung transplant recipients. However, new therapeutic and preventive strategies are highly needed for other viruses such as respiratory syncytial virus (RSV) or parainfluenza virus (PIV), including new antivirals and vaccines. This is particularly important in the advent of the COVID-19 pandemic, for which several unanswered questions remain, in particular on the best antiviral and immunomodulatory regimen for decreasing mortality specifically in lung transplant recipients. In conclusion, the appropriate management of viral complications after transplantation remain an essential step to continue improving survival and quality of life of lung transplant recipients.

Early postoperative complications in lung transplant recipients

Lung transplantation has become an established therapy for end-stage lung diseases. Early postoperative complications can impact immediate, mid-term, and long-term outcomes. Appropriate management, prevention, and early detection of these early postoperative complications can improve the overall transplant course. In this review, we highlight the incidence, detection, and management of these early postoperative complications in lung transplant recipients.

Airway Complications in Lung Transplant Recipients with Telomere-Related Interstitial Lung Disease

PurposePatients with short telomeres and interstitial lung disease (ILD) appear to have increased mortality and bronchiolitis obliterans syndrome after lung transplant. Given the dysfunctional response of short telomere patients to cell damage and stress due to cell senescence, they may be more susceptible to impaired large airway healing. We hypothesized that post-transplant airway complications, including dehiscence and bronchial stenosis, would be more common in the short telomere ILD transplant population.MethodsWe studied 63 recipients transplanted at two centers between 2009 and 2019 with ILD and short telomeres, defined either by telomere length below the 1st percentile for age in any lineage or below the 10th percentile in the lymphocyte lineage by flow-FISH telomere length analysis of peripheral blood lymphocytes, with or without the presence of a known telomere-related mutation. The primary outcomes were the presence of dehiscence or of significant stenosis (i.e. requiring dilation or stenting) after transplant. The control population was 4,359 adult recipients with ILD transplanted over similar years, taken from the Scientific Registry of Transplant Recipients (SRTR).ResultsAmong the short telomere cohort, 6 patients (9.5%) had dehiscence and 9 (14.3%) had stenosis compared to 1.4% and 3.4%, respectively, in the SRTR cohort. When adjusted for age, sex, and bilaterality, the presence of short telomeres was associated with a significantly higher odds of dehiscence (odds ratio (OR)=7.34, 95% confidence interval (CI)=3.01-17.92, p<0.001) and higher odds of stenosis (OR=4.72, 95% CI 2.26-9.85, p<0.001).ConclusionWe identified an association between the presence of short telomeres and post-transplant large airway complications, including dehiscence and significant stenosis. Airway complications may be a contributor to worse outcomes in patients with telomere-related ILD. Patients with short telomeres and interstitial lung disease (ILD) appear to have increased mortality and bronchiolitis obliterans syndrome after lung transplant. Given the dysfunctional response of short telomere patients to cell damage and stress due to cell senescence, they may be more susceptible to impaired large airway healing. We hypothesized that post-transplant airway complications, including dehiscence and bronchial stenosis, would be more common in the short telomere ILD transplant population. We studied 63 recipients transplanted at two centers between 2009 and 2019 with ILD and short telomeres, defined either by telomere length below the 1st percentile for age in any lineage or below the 10th percentile in the lymphocyte lineage by flow-FISH telomere length analysis of peripheral blood lymphocytes, with or without the presence of a known telomere-related mutation. The primary outcomes were the presence of dehiscence or of significant stenosis (i.e. requiring dilation or stenting) after transplant. The control population was 4,359 adult recipients with ILD transplanted over similar years, taken from the Scientific Registry of Transplant Recipients (SRTR). Among the short telomere cohort, 6 patients (9.5%) had dehiscence and 9 (14.3%) had stenosis compared to 1.4% and 3.4%, respectively, in the SRTR cohort. When adjusted for age, sex, and bilaterality, the presence of short telomeres was associated with a significantly higher odds of dehiscence (odds ratio (OR)=7.34, 95% confidence interval (CI)=3.01-17.92, p<0.001) and higher odds of stenosis (OR=4.72, 95% CI 2.26-9.85, p<0.001). We identified an association between the presence of short telomeres and post-transplant large airway complications, including dehiscence and significant stenosis. Airway complications may be a contributor to worse outcomes in patients with telomere-related ILD.

Infectious Complications in Lung Transplant Recipients

Lung transplantation is a lifesaving intervention for patients with advanced lung disease. Due to a combination of immunosuppression, continuous exposure of the lungs to the environment, and complications at the anastomotic sites, lung transplant recipients are at high risk for infectious complications. The aim of this review is to summarize recent developments in the field of infectious diseases as it pertains to lung transplant recipients.

Idiopathic Pulmonary Fibrosis Lung Transplant Recipients are at Increased Risk for Epstein-Barr Virus-Associated Post-Transplant Lymphoproliferative Disorder

Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) is a serious complication in lung transplant recipients (LTRs) associated with significant mortality. We performed a single-center retrospective study to evaluate the risks for PTLD in LTRs over a seven-year period. All LTRs transplanted from 2010 to 2016 were included. LTRs who died within 3 months or were lost to follow-up were excluded. Sex, age, EBV serostatus, induction agent, indication agent, and survival were collected via chart review. The primary outcome was development of PTLD. Secondary endpoints were early and late PTLD and survival. Primary and secondary outcomes were assessed using Kaplan-Meier methods and Cox proportional hazards models. Of 611 evaluable LTRs, we identified 28 cases of PTLD, with an incidence of 4.6%. Kaplan-Meier analysis showed an increased rate of PTLD in idiopathic pulmonary fibrosis (IPF)-LTRs (p<0.02). Multivariable Cox proportional hazards modeling found IPF (HR 3.51, 95% CI 1.33-8.21, p=0.01), alemtuzumab induction therapy (HR 2.73, 95% CI 1.10-6.74, p=0.03), and EBV mismatch (HR: 34.43, 95% CI: 15.57-76.09, p<0.0001) as risk factors for PTLD. Early PTLD (first-year) was associated with alemtuzumab use (p=0.04), whereas IPF was a predictor for late PTLD (after first-year) (p=0.002), after controlling for age and sex. Kaplan-Meier analysis revealed a shorter time to death from PTLD in IPF-LTRs compared to other LTRs (p=0.04). The use of alemtuzumab in EBV-mismatch was found to particularly increase PTLD risk. IPF-LTRs are at increased susceptibility for PTLD compared to non-IPF LTRs. LTRs who received alemtuzumab induction were at increased risk for PTLD, particularly those who were EBV mismatches. Ongoing studies are being conducted to understand the mechanisms driving PTLD in IPF-LTRs and develop strategies to mitigate risk.

Idiopathic pulmonary fibrosis lung transplant recipients are at increased risk for EBV-associated posttransplant lymphoproliferative disorder and worse survival.

Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disorder (EBV-PTLD) is a serious complication in lung transplant recipients (LTRs) associated with significant mortality. We performed a single-center retrospective study to evaluate the risks for PTLD in LTRs over a 7-year period. Of 611 evaluable LTRs, we identified 28 cases of PTLD, with an incidence of 4.6%. Kaplan-Meier analysis showed a decreased freedom from PTLD in idiopathic pulmonary fibrosis (IPF)-LTRs (P<.02). Using a multivariable Cox proportional hazards model, we found IPF (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.33-8.21, P=.01) and alemtuzumab induction therapy (HR 2.73, 95% CI 1.10-6.74, P=.03) as risk factors for PTLD, compared to EBV mismatch (HR: 34.43, 95% CI 15.57-76.09, P<.0001). Early PTLD (first year) was associated with alemtuzumab use (P=.04), whereas IPF was a predictor for late PTLD (after first year) (P=.002), after controlling for age and sex. Kaplan-Meier analysis revealed a shorter time to death from PTLD in IPF LTRs compared to other patients (P=.04). The use of alemtuzumab in EBV mismatch was found to particularly increase PTLD risk. Together, our findings identify IPF LTRs as a susceptible population for PTLD. Further studies are required to understand the mechanisms driving PTLD in IPF LTRs and develop strategies to mitigate risk.

Clinical risk factors for invasive aspergillosis in lung transplant recipients: Results of an international cohort study.

Invasive aspergillosis (IA) is a frequent complication in lung transplant recipients (LTRs). Clinical risk factors for IA have not been fully characterized, especially in the era of extensive anti-fungal prophylaxis. The primary objective of this study was to evaluate the clinical risk factors associated with IA in LTRs. The secondary objective was to assess the mortality in LTRs who had at least 1 episode of IA compared with LTRs who never had experienced IA. We conducted an international, multicenter, retrospective cohort study of 900 consecutive adults who received lung transplants between 2005 and 2008 with 4years of follow-up. Risk factors associated with IA were identified using univariate and multiple regression Cox proportional hazards models. Anti-fungal prophylaxis was administered to 61.7% (555 of 900) of patients, and 79 patients developed 115 episodes of IA. The rate to development of the first episode was 29.6 per 1,000 person-years. Aspergillus fumigatus was the most common species isolated (63% [72 of 115 episodes]). Through multivariate analysis, significant risk factors identified for IA development were single lung transplant (hazard ratio, 1.84; 95% confidence interval, 1.09-3.10; p = 0.02,) and colonization with Aspergillus at 1 year post-transplantation (hazard ratio, 2.11; 95% confidence interval, 1.28-3.49; p = 0.003,). Cystic fibrosis, pre-transplant colonization with Aspergillus spp, and use of anti-fungal prophylaxis were not significantly associated with the development of IA. Time-dependent analysis showed IA was associated with higher mortality rates. Incidence of IA remains high in LTRs. Single-lung transplant and airway colonization with Aspergillus spp. within 1 year post-transplant were significantly associated with IA.

Ureaplasma spp. and Mycoplasma hominis PCR in Respiratory Samples from Lung Transplant Recipients with Hyperammonemia Syndrome and Cerebral Edema

Hyperammonemia syndrome (HS) is a rare and life-threatening complication in Lung Transplant Recipients (LTRs) resulting in brain edema and death if not promptly treated. An association with Ureaplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis (urea splitting organisms) infection has been suggested.