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Pneumonia after Heart Transplantation: Two Case Reports and a Review of the Literature. | LitMetric

AI Article Synopsis

  • Post-transplant pneumonia (PcP) is a serious infection affecting solid organ transplant recipients, particularly during the second year post-transplant, after prophylactic treatments are stopped.
  • Recent cases highlight that PcP can still occur long after patients cease prophylaxis, especially following viral illnesses that increase risk.
  • The report emphasizes the need for more rigorous timing and guidelines on PcP prophylaxis, considers new risk factors, and discusses treatment experiences of patients with severe complications.

Article Abstract

Post-transplant pneumonia (PcP) is an uncommon but increasingly reported disease among solid organ transplantation (SOT) recipients, associated with significant morbidity and mortality. Although the introduction of PcP prophylaxis has reduced its overall incidence, its prevalence continues to be high, especially during the second year after transplant, the period following prophylaxis discontinuation. We recently described two cases of PcP occurring more than one year after heart transplantation (HT) in patients who were no longer receiving PcP prophylaxis according to the local protocol. In both cases, the disease was diagnosed following the diagnosis of a viral illness, resulting in a significantly increased risk for PcP. While current heart transplantation guidelines recommend prophylaxis for up to 6-12 months after transplantation, after that period they only suggest an extended prophylaxis regimen in high-risk patients. Recent studies have identified several new risk factors that may be linked to an increased risk of PcP infection, including medication regimens and patient characteristics. Similarly, the indication for PcP prophylaxis in non-HIV patients has been expanded in relation to the introduction of new medications and therapeutic regimens for immune-mediated diseases. In our experience, the first patient was successfully treated with non-invasive ventilation, while the second required tracheal intubation, invasive ventilation, and extracorporeal CO2 removal due to severe respiratory failure. The aim of this double case report is to review the current timing of PcP prophylaxis after HT, the specific potential risk factors for PcP after HT, and the determinants of a prompt diagnosis and therapeutic approach in critically ill patients. We will also present a possible proposal for future investigations on indications for long-term prophylaxis.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610317PMC
http://dx.doi.org/10.3390/pathogens12101265DOI Listing

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