Infection screening at listing and vaccination management through the waiting period in lung transplant candidates in Japan.

Infectious complications remain a major contributor to morbidity and mortality after lung transplantation. In Japan, prolonged waiting periods are a major challenge for lung transplant candidates, during which infection-related risk evolves with new exposures, exacerbations, and hospitalizations. This review provides a practice-oriented approach to infection screening at listing and vaccination management throughout the waiting period for lung transplantation in Japan. Baseline screening at listing is organized into universal serologies, respiratory microbiology (bacteria, moulds, and nontuberculous mycobacteria), reservoir evaluation (e.g., sinonasal and dental foci), and exposure-driven tests. Vaccination should be completed as early as feasible during the waiting period to maximize immunogenicity before immunosuppression, with prioritization of respiratory vaccines and careful assessment of eligibility for live vaccines. Because airway colonization patterns and resistance profiles change over time, respiratory cultures and susceptibilities should be updated through scheduled reassessment, event-driven testing, and pretransplant confirmation to inform peri‑transplant antimicrobial planning. Although centered on Japan, this workflow is intended to be adaptable to donor-limited programs and other regions where prolonged waiting periods necessitate time-based reassessment and prevention.