Pneumonia is a common infectious complication in solid organ transplantation (SOT) that necessitates inpatient care. Guidelines do not provide specific recommendations for radiological follow-up of pts treated for pneumonia. SOT patients (pts) are at risk of pneumonia caused by atypical and opportunistic pathogens. In addtion, SOT increases risk of malignancy. Follow-up imaging may identify persistent radiographic abnormalities that require further investigation. We evaluated the frequency of follow-up imaging done to ascertain resolution of pneumonia or identification of an alternative diagnosis, in SOT pts with pneumonia.
This retrospective study was conducted at Henry Ford Hospital, a large transplant center. All SOT pts with a discharge diagnosis of pneumonia during 2013 were identified. Data including demographics, radiographic data and outcomes were analyzed. We evaluated for radiographic resolution/persistance at 6 weeks and 12 months from index hospitalization.
We identified 39 SOT pts with pneumonia during the study period, 26 (67%) were men. Distribution based on transplant type: liver 31%, kidney 31%, heart 23%, multiorgan 11%, lung 5%. Median time from SOT to pneumonia was 6 years (IQ 2.25-11.8). Diagnosis of community-acquired pneumonia was made in 18 (47%), healthcare associated pneumonia in 19 (50%) and post-obstructive pneumonia (3%). All cases had features of pneumonia on initial chest radiograph and 16 (49%) had findings confirmed on CT scan of chest. Repeat imaging within 6 weeks was done in 27 (75%) pts. Follow up imaging showed resolution of findings in 21 (78%) cases. At 1 year 22 (56%) pts had repeat imaging done and 2 of 22 had persistent radiographic findings with a subsequent diagnosis of PTLD and squamous cell carcinoma of lung. Invasive pulmonary aspergillosis occurred in one patient that lacked follow up imaging.
In SOT recipients with a diagnosis of pneumonia, routine follow-up radiographic imaging at and beyond 6 weeks may be considered to mitigate the risk of opportunistic infection or malignancy.
O. Abreu Lanfranco,
M. Ramesh, None
R. Del Busto, None
G. Alangaden, None
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