• Oana Joean, Tobias Welte, and Jens Gottlieb.
• Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
• Chest. 2022 Apr 1; 161 (4): 937-948.

AbstractDespite substantial progress in long-term follow-up strategies for lung transplant recipients, morbidity and mortality remain high, mostly because of the elevated infectious risk and the development of chronic lung allograft dysfunction. The high immunosuppressive levels necessary to prevent acute rejection and the graft's constant exposure to the environment come at the high price of frequent infectious complications. Moreover, some infectious agents have been shown to trigger acute rejection or chronic allograft dysfunction. A rapid diagnostic approach followed by an early treatment and follow-up strategy are of paramount importance. However, these are challenging endeavors because of the vast spectrum of possible pathogens and the discrete clinical features resulting form transplant recipients' impaired immune responses. This review proposes a stratified diagnostic strategy and discusses the most relevant pathogens and the corresponding therapeutic approaches, while also offering insight on infection prevention strategies: vaccination, prophylaxis, pre-emptive therapy, and antibiotic stewardship.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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