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Lung Transplantation

Complications of Lung Transplantation - Infection and Malignancies

After a lung transplant, patents are generally given drugs that will suppress the body's natural immune system. This is to prevent the body from rejecting the new lungs.

Because the body's immune system is being suppressed, patients may have an increased risk of infection, especially during the first six months when dosages are higher because of the increased risk of rejection.

This feature contains information on:

Signs and Symptoms of Infection

Types of Infection

Infections may be viral, bacterial, fungal, or protozoan.

Bacterial Infections

Some of the most common types of infections post-transplant are bacterial infections. Bacterial infections are caused by organisms that inhabit the skin or body cavities. These organisms rarely cause problems for persons with normal immune systems, but they may lead to infections in someone whose immune system is being suppressed.

Bacterial infections may occur at any site. If your doctor suspects that you have a bacterial infection you may have to have blood, sputum, and urine cultures and a chest X-ray. In some instances a bronchoscopy can help to isolate the cause of an infection in the lung. Depending on the cause and the severity of the infection, patients may need to take antibiotics either by mouth or intravenously.

Viral Infections

Viral infections include CMV (cytomegalovirus) and herpes (simplex or zoster) and influenza. During the pre-transplant evaluation, testing will be done for previous exposure to CMV and herpes infections as well as hepatitis and HIV.

CMV - CMV at one point was a common infection in lung transplant patients. Modern developments of oral drugs that protect against CMV and screening tests to detect CMV in the bloodstream have significantly decreased the burden of this agent in lung transplants. Nonetheless, prevention of and screening for CMV disease remains an important element of post-transplant care. CMV in non-transplant patients, is usually a self-limited infection characterized by mild flu-like symptoms. They include:

More than 50 percent of Americans have had previous exposure to CMV. In a patient with a suppressed immune system, CMV may cause a more serious illness.

Patients who have previously been exposed to CMV, or whose donor had previous exposure, are treated with a combination of ganciclovir and/or vanganciclovir for several months or longer after transplant. Antibodies against CMV are contained in a purified blood product preparation called cytogam may also be useful in the management of CMV disease.

Herpes - Herpes is present in as much as 40 percent of the transplant population. The virus commonly affects people during childhood. Symptoms may include fever blisters around the mouth, in the esophagus, the genital area or anus.

After the blisters have disappeared, the virus remains latent on the nerve roots. It may appear later as skin eruption called shingles and cause painful blisters along nerve pathways on the surface of the skin, most commonly on the chest, flank, and face. Avoid persons with active chicken pox because the virus may cause a more severe infection in recipients who never had exposure, or may cause shingles in patients who had chicken pox previously. Herpes infections are treated with acyclovir.

Fungal Infections

Fungal infections, such as candida, aspergillosis, and histoplasmosis may range from mild (thrush) to life threatening.

Candida - Candida is yeast that grows in warm moist areas of the body, such as the mouth, arm pits, groin, and genital area. It is also known as thrush or monilla. When it occurs in the mouth, candida can be treated with Mycostatin mouthwash or Mycolex troches; when it occurs on the skin it can be treated with lotions. If it occurs in the body it may require treatment with oral or intravenous anti-fungal medicines.

Aspergillosis - Aspergillosis may be contracted by breathing fungal spores in damp musty places, such as attics, basements, barns, construction sites, freshly dug gardens or mowed grass. Take care to avoid these areas or, if necessary, wear a mask in those environments. The development of oral antifungal medications with activity against aspergillus have dramatically decreased the incidence of these infections in lung transplant patients.

Histoplasmosis - Histoplasmosis is an air-borne fungal disease found in bird droppings. Avoid exposure to bird droppings, especially in enclosed areas.

 

Other Infections

 

Pneumocystis - Pneumocystis is a pulmonary infection that occurs primarily in patients who are immunosuppressed. Its symptoms include cough, fever, general discomfort, and shortness of breath.

Preventing Infection

The most important thing to remember is to use common sense. Good hand washing, cleanliness, and personal hygiene help prevent infection.

While you are in the hospital, the ICU may have special procedures and guidelines for preventing infection:

Other precautions to take:

Guide to Vaccines

*Live Virus Vaccines include:

Inactivated Virus Vaccines

Malignancies

Transplant patients are more susceptible to malignant tumors (cancers) than the general population. The body normally tries to defend against malignant cells via its immune system. However, because the immune system is being suppressed to preserve the transplanted lungs, malignant cells may escape detection by the immune system and develop into a tumor.

Skin cancers - Skin cancers are the most common tumor in transplant patients, and sun exposure is the major risk factor. Always wear sunscreen on exposed areas when outside in bright sunlight. Wear a hat when out in the sun for long periods of time. Routine dermatology evaluations are often suggested in transplant recipients.

Lymphomas - Lymphomas occur with greater frequency in transplant patients. They may be first noticed as an enlarged lymph node on an X-ray. Some lymphomas or lymphoma- like syndromes especially Post Transplant Lymphoproliferative Disorder (PTLD) may be associated with Epstein Barr virus infections. Symptoms may include fever, malaise, weight loss, poor appetite or sweating.

This information originally appeared in the University Hospitals Lung Transplantation Patient Handbook, and was adapted for use on NetWellness with permission, 2007.

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Last Reviewed: Aug 27, 2013

Robert  Schilz, DO, PhD Robert Schilz, DO, PhD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University