Infections in lung transplantation: new insights.

PURPOSE OF REVIEW: Infections represent a major source of complications in lung transplant recipients (LTR), especially when compared with recipients of other solid organ transplants. Within the past year, new data on the impact and prevention of specific pathogens in the setting of lung transplant have been published. Specifically, this review will assess the effect of Burkholderia infection on cystic fibrosis (CF) patients following lung transplant (LTx), the role that Gram-negative bacilli (GNB) play in the development of bronchiolitis obliterans syndrome (BOS), and the optimal duration of cytomegalovirus (CMV) prophylaxis in LTR.

RECENT FINDINGS: Recent data support the hypothesis that certain Burkholderia species, potentially B. gladioli and specific B. cenocepacia subtypes, pose a greater risk for death in CF LTR than do other Burkholderia species. Additionally, recent data suggest that colonization with GNB, particularly Pseudomonas species, may play a role in the pathogenesis of BOS, the leading cause of late-term mortality in LTR. Finally, recent studies suggest that extended prophylactic regimens may be more efficacious in reducing CMV-related events.

SUMMARY: Recent data have broadened our understanding of the role that infections play in affecting LTR outcomes. Prospective multicenter studies are needed to further optimize pathogen specific prevention strategies.