Abstract：
BACKGROUND: Hospital- (HAP) and ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, associated factors and outcomes are not well reported.
METHODS: LT recipients transplanted at our institution (07/2019-01/2020 and 10/2021-11/2022) were prospectively included. We assessed incidence and presentation of pneumonia and evaluated the impact of associated factors using regression models. In addition, we evaluated molecular relatedness of respiratory pathogens collected peri-transplant and at pneumonia occurrence using pulsed-field-gel-electrophoresis (PFGE).
RESULTS: In the first 30 days post-LT, 25/270 (9.3%) recipients were diagnosed with pneumonia (68% [17/25] VAP; 32% [8/25] HAP). Median time to pneumonia was 11 days (IQR 7-13). 49% (132/270) of donor and 16% (44/270) of recipient respiratory peri-transplant cultures were positive. However, pathogens associated with pneumonia were not genetically related to either donor or recipient cultures at transplant, as determined by PFGE.Diagnosed pulmonary hypertension (HR 4.42, 95% CI 1.62-12.08) and immunosuppression use (HR 2.87, 95% CI 1.30-6.56) were pre-transplant factors associated with pneumonia.Pneumonia occurrence was associated with longer hospital stay (HR 5.44, 95% CI 2.22-13.37) and VAP with longer ICU stay (HR 4.31, 95% CI: 1.73-10.75) within the first 30 days post-transplant; 30- and 90-day mortality were similar.
CONCLUSIONS: Prospectively assessed early pneumonia incidence occurred in around 10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients.
METHODS: LT recipients transplanted at our institution (07/2019-01/2020 and 10/2021-11/2022) were prospectively included. We assessed incidence and presentation of pneumonia and evaluated the impact of associated factors using regression models. In addition, we evaluated molecular relatedness of respiratory pathogens collected peri-transplant and at pneumonia occurrence using pulsed-field-gel-electrophoresis (PFGE).
RESULTS: In the first 30 days post-LT, 25/270 (9.3%) recipients were diagnosed with pneumonia (68% [17/25] VAP; 32% [8/25] HAP). Median time to pneumonia was 11 days (IQR 7-13). 49% (132/270) of donor and 16% (44/270) of recipient respiratory peri-transplant cultures were positive. However, pathogens associated with pneumonia were not genetically related to either donor or recipient cultures at transplant, as determined by PFGE.Diagnosed pulmonary hypertension (HR 4.42, 95% CI 1.62-12.08) and immunosuppression use (HR 2.87, 95% CI 1.30-6.56) were pre-transplant factors associated with pneumonia.Pneumonia occurrence was associated with longer hospital stay (HR 5.44, 95% CI 2.22-13.37) and VAP with longer ICU stay (HR 4.31, 95% CI: 1.73-10.75) within the first 30 days post-transplant; 30- and 90-day mortality were similar.
CONCLUSIONS: Prospectively assessed early pneumonia incidence occurred in around 10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients.
摘要：
背景：医院（HAP）和呼吸机相关性肺炎（VAP）是肺移植（LT）后早期（<30天）的重要并发症。然而,当前发生率，相关因素和结局没有得到很好的报道。
方法：前瞻性纳入在我们机构移植的LT受体（07/2019-01/2020和10/2021-11/2022）。我们评估了肺炎的发生率和表现，并使用回归模型评估了相关因素的影响。此外,我们使用脉冲场凝胶电泳(PFGE)评估了在移植期间和肺炎发生时收集的呼吸道病原体的分子相关性.
结果：在LT后的前30天，25/270(9.3%)受者被诊断为肺炎(68%[17/25]VAP;32%[8/25]HAP)。肺炎的中位时间为11天（IQR7-13）。49％（132/270）的供体和16％（44/270）的受体呼吸道周围移植培养物呈阳性。然而,与肺炎相关的病原体在移植时与供体或受体培养物没有遗传关系，由PFGE确定。已诊断的肺动脉高压（HR4.42，95％CI1.62-12.08）和免疫抑制使用（HR2.87，95％CI1.30-6.56）是与肺炎相关的移植前因素。在移植后的前30天内，肺炎的发生与住院时间较长（HR5.44，95％CI2.22-13.37）和ICU住院时间较长（HR4.31，95％CI：1.73-10.75）的VAP相关；30天和90天的死亡率相似。
结论：前瞻性评估早期肺炎发生率约为LT的10%。肺炎发生风险增加的人群包括LT伴移植前肺动脉高压和移植前免疫抑制。肺炎与医疗保健使用增加有关，强调需要通过优先针对高风险患者进一步改善.
方法：前瞻性纳入在我们机构移植的LT受体（07/2019-01/2020和10/2021-11/2022）。我们评估了肺炎的发生率和表现，并使用回归模型评估了相关因素的影响。此外,我们使用脉冲场凝胶电泳(PFGE)评估了在移植期间和肺炎发生时收集的呼吸道病原体的分子相关性.
结果：在LT后的前30天，25/270(9.3%)受者被诊断为肺炎(68%[17/25]VAP;32%[8/25]HAP)。肺炎的中位时间为11天（IQR7-13）。49％（132/270）的供体和16％（44/270）的受体呼吸道周围移植培养物呈阳性。然而,与肺炎相关的病原体在移植时与供体或受体培养物没有遗传关系，由PFGE确定。已诊断的肺动脉高压（HR4.42，95％CI1.62-12.08）和免疫抑制使用（HR2.87，95％CI1.30-6.56）是与肺炎相关的移植前因素。在移植后的前30天内，肺炎的发生与住院时间较长（HR5.44，95％CI2.22-13.37）和ICU住院时间较长（HR4.31，95％CI：1.73-10.75）的VAP相关；30天和90天的死亡率相似。
结论：前瞻性评估早期肺炎发生率约为LT的10%。肺炎发生风险增加的人群包括LT伴移植前肺动脉高压和移植前免疫抑制。肺炎与医疗保健使用增加有关，强调需要通过优先针对高风险患者进一步改善.
