Background: The incidence of pulmonary complications in
heart transplant recipients has not been extensively studied. We report
pulmonary complications in 159 consecutive adult orthotopic heart
transplantations (OHTs) performed in 157 patients.
and methods: Retrospective review of medical records.
Results: Forty-seven of 159 recipients (29.9%) had
81 pulmonary complications. Pneumonia was the most common (n = 27),
followed by bronchitis (n = 15), pleural effusion (n = 10),
pneumothorax (n = 7), prolonged respiratory failure requiring
tracheotomy (n = 7), and obstructive sleep apnea syndrome (n = 6).
All patients with late-onset (> 6 months after transplantation)
community-acquired bacterial pneumonia presented with fever, cough, and
a new lobar consolidation on the chest radiograph, and responded
promptly to empiric antibiotics without undergoing an invasive
diagnostic procedure. In contrast, early-onset nosocomial bacterial
pneumonias carried a 33.3% mortality rate. A positive tuberculin skin
test result was associated with a significantly higher rate of
pulmonary complications (62.5% vs 26.8%, p = 0.007). Lung cancer
and posttransplant lymphoproliferative disorder (PTLD) developed
exclusively in 6 of the 61 patients (8.1%) who received induction
immunosuppression with murine monoclonal antibody (OKT3).
Conclusion: Pulmonary complications are common following
heart transplantation, occurring in 29.9% of recipients, and are
attributed to pneumonia of primarily bacterial origin in one half of
cases. Late-onset community-acquired pneumonia carried an excellent
prognosis following empiric antibiotic therapy, suggesting that in the
appropriate clinical setting invasive diagnostic procedures are
unnecessary. Analogous to reports in other solid-organ transplant
recipients, induction therapy with OKT3 was associated with an
increased incidence of lung cancer and PTLD. Overall, the development
of pulmonary complications after OHT has prognostic significance given
the higher mortality in this subset of