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Semin Respir Crit Care Med
DOI: 10.1055/a-2708-4873
Review Article

Pneumonia After Solid Organ Transplantation

Authors

  • Paula O. Narvaez-Ramirez

    1   Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia

  • Ingrid G. Bustos

    1   Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
    2   Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia

  • Cristian C. Serrano-Mayorga

    1   Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
    3   Doctorado en Biociencias, Facultad de Ingeniería Universidad de La Sabana, Chía, Colombia

  • Luis F. Reyes

    1   Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
    2   Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
    4   Infectious Diseases, Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
    5   ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

Funding Information This study was sponsored by Universidad de La Sabana, Chia, Colombia (grant no.: MED-260-2019), Gates Foundation (grant no.: INV-063472), and Wellcome Trust (grant no.: 303666/Z/23/Z).
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Abstract

Solid organ transplantation (SOT) has significantly increased over the past few decades, with more than 170,000 SOTs performed worldwide in 2023. Although immunosuppressive treatments have improved patient survival, they have also increased the risk of infections among SOT recipients (SOTRs), especially pneumonia. Pneumonia remains one of the leading causes of morbidity and mortality, with respiratory infections contributing to 30 to 70% of deaths in SOTRs, depending on the organ transplanted and the timing of infection. This review summarizes current knowledge on the epidemiology, risk factors, microbial etiology, and clinical manifestations of pneumonia in SOTRs. Temporal patterns of infection are also explored, with early posttransplant infections frequently caused by nosocomial or donor-derived pathogens, and community-acquired infections predominating beyond 6 to 12 months posttransplantation. The lack of robust, SOT-specific guidelines for pneumonia complicates the management of this entity in SOTRs. Most recommendations are based on extrapolations from immunocompetent populations. Furthermore, the lack of large, prospective trials comparing empirical antibiotic strategies in SOTRs limits evidence-based decision-making. Despite these challenges, early initiation of empirical therapy remains crucial to improving outcomes. The review highlights the importance of timely microbiological diagnosis, individualized antimicrobial stewardship, and targeted therapeutic approaches in the context of increasing antimicrobial resistance. Incorporating local epidemiological data and patient-specific risk profiles may enhance the accuracy of diagnosis and support the de-escalation of therapy upon pathogen identification.

Keywords

solid organ transplant - pneumonia - immunosuppressive therapy - infection risk


Publication History

Received: 14 August 2025

Accepted: 23 September 2025

Accepted Manuscript online:
24 September 2025

Article published online:
17 October 2025

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