Introduction

Infection is the major cause of both morbidity and mortality post lung transplantation [1, 2]. It is usually the final common pathway complicating any significant insult to the allograft, be that in the early postoperative period, when ischaemia–reperfusion injury and high levels of immunosuppression increase the risk, through to the end-stages of the transplant marked by the presence of obliterative bronchiolitis.

Throughout the life of the transplant, even when patients are well with normal allograft function, the risk of infection is ever present. This is in part because of the ongoing need for immunosuppression, but also because of unique features associated with the lung. The lung allograft is unique among solid organ transplants in that it remains in direct contact with the external environment. This exposes the allograft to the numerous potential infectious agents and allergens that cause many of the problems encountered both immediately post-transplantation and in the longer term. In addition, the normal physiological and anatomical mechanisms that help to prevent infection in the healthy lung (such as coughing and mucociliary clearance) are disrupted by the transplantation operation, adding to the risk of developing infection. This is a particular problem in the immediate postoperative period.

Here, the infectious complications of lung transplantation will be considered in two ways. First, we will look at the issues relevant to the different phases of transplantation, by considering the assessment and management of infection associated with the recipient, donor, perioperative phase and long-term survival. Second, we will consider individual organisms and the features associated with their presentation, diagnosis and treatment in lung transplant recipients.