What are the risk factors for pneumonia in immunocompromised transplant patients?

Updated: Jan 07, 2019
  • Author: Julie B Zhao, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Solid-organ and bone-marrow transplant patients have a heightened risk of pulmonary infection as well. The specific organ, timeframe since transplant, and use of immunosuppressive medications are all important in predicting these complications.

CMV pneumonitis is common in solid organ transplant, particularly lung, recipients. The risk is higher if the donor is seropositive and the recipient seronegative. Interestingly, the opposite is seen in hematological stem cell transplant (HCT) patients, where there is a higher risk for CMV pneumonitis among seropositive recipients transplanted with seronegative stem cells.

Nocardia species are another notable cause of pulmonary infection in organ transplant patients requiring long-term immunosuppression.

Reactivation of viruses causing pneumonia is a large concern in HCT patients, even in autologous transplants. Human herpesvirus 6 (HHV-6) reactivation is most common (seen in up to 60% of patients), followed by EBV (up to 30%). [36, 37, 38]

HHV-6 infection is especially important in that it has been shown to be a predictor of subsequent CMV infection. [39]

Solid organ and HCT recipient are at risk also of hyperinfection with Strongyloides stercoralis, which may be accompanied by gram-negative bacterial sepsis and pneumonia.

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