The incidence of Pneumocystis carinii pneumonia (PCP) has been shown to be high posttransplantation in the absence of prophylaxis.

The incidence of Pneumocystis carinii pneumonia (PCP) has been shown to be high posttransplantation in the absence of prophylaxis. For this reason, lung transplant recipients routinely receive prophylaxis. We report forward our results using aerosolized pentamidine prophylaxis in nine patients post-lung transplantation (eight single lung transplants, single in kind double). The patients received monthly treatments of 300 mg of aerosolized pentamidine for a mean of 106 month (range, 4 to 21 months) Patients were routinely monitored with serial pulmonary function studies and bronchoscopy as clinically indicated. pair of the patients experienced bronchospasm in answer to the therapy. None of the patients experienced any episodes of PCP during the period of inhaled pentamidine prophylaxis. Inhaled pentamidine is a safe and effective form of PCP prophylaxis and may be used instead of sulfamethoxazole-trimethoprim in patients who have a sulfa allergy or other untoward sulfa side effects

The incidence of Pneumocystis carinii pneumonia (PCP) posttransplantation in the absence of prophylaxis has been shown to be in the order of 3 to 15 percent[1] In heart-lung recipients, a prevalence as high as 88 percent has been reported, although single 43 percent of these patients had symptomatic disease.[2] The preferr form of prophylaxis for PCP is oral administration of trimethoprim-sulfamethoxazole.[3] Other forms of prophylaxis are available, united of which is inhaled pentamidine. This modality gained favor and was used extensively in AIDS patients in the late 1980 and early 1990 following reports of reduced efficacy as well as higher take away froms and logistical problems with its administration have be deriveded in this form of prophylaxis falling into disfavor. Despite the efficacy of orally administered trimethoprim-sulfamethoxazole, there is still a ne for alternate forms of prophylaxis for the occasional patient with a sulfa allergy or other untoward inhale sulfa-related side events We report on our arises using inhaled pentamidine as prophylaxis for PCP in a dispose of patients post-lung transplantation.

MATERIALS AND METHODS

Subjects

We retrospectively analyzed the charts of nine patients who have received inhaled pentamidine as part of their postoperative management. The underlying disease entities for which these patients received lung transplants included COPD [4] pulmonary fibrosis [3] primary pulmonary hypertension [1] and lymphangiolyomyomatosis [1] There were three right single, five left single, and the same double lung transplants. Five of the patients were female and four were male.

Immunosuppression

All patients received induction immunosuppression in the immediate postoperative period with either OKT 3 (Ortho), 5 mg/d (n = 8) or Minnesota anti-lymphocyte globulin (n = 1) 5 mg/kg/d for five to seven days. All patients have received maintenance immunosuppression therapy with cyclosporin A, azathioprine, and prednisone. Rejection episodes were treated with intravenous methylprednisolone administered as a bolus of 1 g daily for 3 days, followed at an increase in orally administered prednisone that was tapered slowly through the whole extent of periods of between 3 and 6 weeks.

Prophylaxis Regimen

The patients received 300 mg of aerosolized pentamidine forward a monthly basis via a Respirgard II nebulizer unit (Marquest productions Colorado). The pentamidine was dissolved in 5 ml of sterile water. The nebulizer unit was powered by means of compressed oxygen at a deliquesce rate of 6 to 8 L/min. Delivery was terminated when the nebulizer was devoid of contents The patients were instructed to breathe normally [i]or[/i] part of to the other the mouth-piece with vital capacity maneuvers each four to five breaths. All patients received their treatments in the seated position. All patients were premedicated prior to treatments with albuterol administered via a meter dose inhaler or hand-held nebulizer.

Surveillance

Episodes of PCP were exclud by means of Gomori methenamine silver staining of bronchoalveolar lavage fluid specimens obtained at bronchoscopy Bronchoscopy was performed as clinically indicated.

Serial pulmonary function studies (spirometry) also were routinely obtained for all patients as part of their clinical management. For each patient, the spirometry proof with the maximum [FEV.sub.1] from the three spirometry standards done immediately preceding the physic change was used to show the pentamidine period; likewise, the spirometry proof with the maximum [FEV.sub.1] from the three spirometries immediately succeeding the mix with drugs switch were used to give an account of the postpentamidine period.

Patients were initially given prophylaxis with aerosolized pentamidine after transplantation and were subsequently switched from one side of to the other to orally administered trimethoprim-sulfamethoxazole. The reason for this change in our protocol was the growing carcass of literature that attested to the casualty of breakthrough episodes of Pneumocystis infections in patients receiving inhaled pentamidine prophylaxis.[4,5]

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