Early bacterial pulmonary infections within 2 weeks after lung transplantation were studied in 29 patients undergoing surgery between December 1989 and May 1992 Suspected pulmonary infections occurr in 11 patients (38 percent) The chiefly common bacterial organisms isolated were Klebsiella pneumoniae (45 percent; 5/11) Pseudomonas aeruginosa (36 percent; 4/11) Escherichia coli (27 percent; 3/11) Staphylococcus aureus (18 percent; 2/11) and Enterobacter cloacae (18 percent; 2/11) The mortality to be paid to infection was 3 percent (1/29) in the early postoperative period.

Early bacterial pulmonary infections within 2 weeks after lung transplantation were studied in 29 patients undergoing surgery between December 1989 and May 1992 Suspected pulmonary infections occurr in 11 patients (38 percent) The chiefly common bacterial organisms isolated were Klebsiella pneumoniae (45 percent; 5/11) Pseudomonas aeruginosa (36 percent; 4/11) Escherichia coli (27 percent; 3/11) Staphylococcus aureus (18 percent; 2/11) and Enterobacter cloacae (18 percent; 2/11) The mortality to be paid to infection was 3 percent (1/29) in the early postoperative period. None of the following variables was raise to be of prognostic significance: positive donor agricultures ischemic time of the graft, use of cardiopulmonary bypass, number of courses of methylprednisolone for acute rejection, duration of postoperative intubation, and sign of surgical procedure. The carriage of infection in the early postoperative period did not influence long-term survival. In the absence of prognostic parameters, active adjustment of antibiotic therapy to the deductions of antibiograms remains the most numerous important therapeutic step in the management of infections in the early postoperative period after lung transplantation.

(Chest 1993; 104:1412-16)

ATG = antithymocyte globulin; [FIo.sub.2] = fraction of oxygen in the inspired gas; HPLC = high performance liquid chromatography; LTx = lung transplantation, MU = mega unit; OPF = oropharyngeal flora.

Lung transplantation has become an acceptable treatment in end-stage lung disease.[1-5] The diagnosis and treatment of infection and rejection in immunocompromised patients are challenging vexed questions for physicians and surgeons. Infection is single in kind of the most common causes of death in the postoperative period. Whereas fungal, protozoal, and viral infections come into one's head later,[6-8] bacterial infections with pneumonia as the main manifestation have a peak incidence in the first 2 postoperative weeks.[9-10]

In a retrospective thought we analyzed the incidence and nature of bacterial pulmonary infections in lung transplant recipients within 2 weeks after operation in order to find putative prognostic factors for bacterial infection in this period.

Materials and Methods

Patients and Surgical Procedure

Between December 1989 and May 1992 there were 29 patients who underwent lung transplantation (LTx) (17 double; 12 single) at the inferior Department of Surgery, University of Vienna. There were 16 men and 13 women with a mean age of 44 years (range, 22 to 67 years). Indications for surgery were idiopathic pulmonary fibrosis (n=12) emphysema (n=8) bronchiectasis (n=2) cystic fibrosis (n = 2) primary pulmonary hypertension (n = 2) secondary pulmonary hypertension (n = 2) and Eisenmenger's syndrome with atrial septal foible (n = 1).

Donor Selection. Donors were pitch uponed according to ABO blood-group compatibility and were matched with the recipient for size, dead body weight, and chest circumference. For acceptance of the donor, a clear chest roentgenogram (for single lung transplantation, barely on the transplanted side), a Pa[O.sub.2], greater than 120 mm Hg at ventilation with a fractional concentration of oxygen in the inspired gas ([FIo.sub.2]) of 30 to 45 percent and a positive end-expiratory constraining force (PEEP) of 5 cm [Hsub2]O were required. Fiberoptic bronchoscopy was performed to withhold aspiration or severe bronchitis. Moderate bronchitis was not a criterion for exclusion from transplantation. Lung preservation and explantation were performed as described elsewhere.[11] The donors comprised 21 male and 8 female enthralls with a mean age of 27 [+ or -] 10 years (SD) (range, 10 to 53 years). The causes of death were cerebral trauma (n = 18) bleeding from cerebral aneurysms (n = 7) cerebral thrombosis (n = 2) and glioblastoma (n = 1) The mean ischemic time was 303 min (range, 130 to 480 min).

Surgical process Surgery in the recipient was performed via a posterolateral thoracotomy for single lung transplantation and via an anterior bilateral transsternal thoracotomy for sequential double lung transplantation. The bronchial anastomoses were performed either in spyglass technique or in end-to-end fashion.[11] In the period of subject of attention no bronchial anastomotic problems as it is as dehiscence or stenosis occurred

Immunosuppression

Induction of immunosuppression was started during surgery with 1000 mg of methylprednisolone, followed by the agency of 3 doses of 125 mg each 8 h after surgery Azathioprine was administered after surgery at a dosage of 2 mg/kg/day and was consecutively adjusted to the leukocyte look upon (WBC count >4.5 x [10sup2]/L) Depending forward renal function, cyclosporin A was started intravenously at 24 to 48 h after surgery to achieve a whole offspring level of about 300 ng/ml as measured by dint of high-performance liquid chromatography (HPLC) (Biorad). Antithymocyte globulin (ATG) was given at a dosage of 10 mg/kg/day for the first 3 postoperative days. Intravenous therapy with methylprednisolone was followed at oral administration of corticosteroids at a dosage of 1 mg/kg/day, which was consecutively reduc to 05 mg/kg/day in the first 2 postoperative weeks.[11]

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