Abstract Results Introduction: Pneumonia, a common infectious complication in solid organ transplantation (SOT) necessitating inpatient-care. Guidelines do not provide specific recommendations for radiological follow-up of pneumonia treated pts. SOT pts have pneumonia risk caused by atypical and opportunistic pathogens. Additionally, SOT increases malignancy risk. Follow-up imaging may identify persistent radiographic abnormalities requiring further investigation. We evaluated frequency of follow-up imaging done to ascertain pneumonia resolution or identification of alternative diagnosis, in SOT pneumonia patients. Methods: Retrospective study of SOT recipients with discharge diagnosis of pneumonia during 2013 at Henry Ford Hospital were identified. Data including demographics, radiographic and outcomes analyzed. Evaluated for radiographic resolution/persistence at 6 weeks and 12 months from index hospitalization. Results: Identified 39 SOT recipients with pneumonia during the study period, 26 (67%) were men. Transplant distribution: liver 31%, kidney 31%, heart 23%, multiorgan 11%, lung 5%. Median time SOT to pneumonia 6 years (IQ 2.25-11.8). Community-acquired pneumonia diagnosis in 18 (47%), healthcare associated 19 (50%) and post-obstructive (3%). All cases had pneumonia features on initial chest radiograph, 16 (49%) findings confirmed on chest CT. Repeat imaging within 6 weeks done in 27 (69%). Follow-up imaging showed resolution in 21 (78%) cases. At 1 year 22 (56%) cases had repeat imaging, 2 of 22 had persistent radiographic findings with subsequent diagnosis of PTLD and lung squamous cell carcinoma. Invasive pulmonary aspergillosis has diagnosed later in one patient lacking follow-up imaging. Conclusions: SOT recipients with diagnosis of pneumonia, routine follow-up radiographic imaging at and beyond 6 weeks may be considered to mitigate risk of opportunistic infection or malignancy.

•  We identified 39 SOT recipients with a discharge after a diagnosis of pneumonia during the study period.

•  Pneumonia was more common in men, 26 cases (67%) •  Median time from initial transplant to index admission for pneumonia

was 6 years (IQ 2.25-11.8) •  All cases had an initial chest radiograph confirming the diagnosis of

pneumonia. •  CT scan performed in 16 cases, and confirmed findings of an infiltrate.

•  At one year, 22/39 patients had repeat imaging. Of these patients, 2 had persistent findings and were later on diagnosed with lung squamous cell carcinoma and post-transplant lymphoproliferative disease (PTLD).

•  Three patients were treated for a new pneumonic process in the

following 6 months after initial admission. •  In the group without follow up imaging, 1/17 was later on

diagnosed with invasive Aspergillosis.

Introduction

Conclusion

•  Pneumonia, is a common infectious complication in solid organ transplantation (SOT) recipients necessitating inpatient-care. These patients have pneumonia risk caused by atypical and opportunistic pathogens, along with common agents.

•  Guidelines do not provide specific recommendations for radiological follow-up of patients treated for pneumonia, for resolution of symptoms and concerns of high risk for malignancy.

•  Follow-up imaging may identify persistent radiographic abnormalities requiring further investigation. We evaluated frequency of follow-up imaging done to ascertain pneumonia resolution or identification of alternative diagnosis, in SOT pneumonia patients.

Methods

Bibliography 1. M. Green. Introduction: Infections in Solid Organ Transplantation .American Journal of

Transplantation 2013; 13: 3–8 2. Allan S. Brett, MD reviewing Tang KL et al. Arch Intern Med 2011 Jul 11(Accessed on April 23,

2002, at http://www.law.stanford.edu/ features/greely/.) 3. Tang KL et al. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in

3398 patients with pneumonia. Arch Intern Med 2011 Jul 11; 171:1193. 4. Brent P. Little, Matthew D. Gilman, Kathryn L. Humphrey et. al. Outcome of Recommendations for

Radiographic Follow-Up of Pneumonia on Outpatient Chest Radiography. American Journal of Roentgenology. 2014;202: 54-59.

Poster 1219 Contact email: oabreu2@hfhs.org

•  We conducted a retrospective case review of all solid organ transplant recipients discharged from Henry Ford Hospital in the 2013 calendar year with diagnosis of pneumonia.

•  Cases were identified based on discharge codes via a central database from our corporate office.

•  We excluded hematopoietic stem cell transplants •  Data analyzed during this review included demographics, type of

transplant, time from initial transplant to first admission for pneumonia, radiographic findings of tests performed in the Henry Ford Health System, type of studies performed with pattern description. Finally, we recorded outcomes, including mortality and readmission.

•  After the initial discharge, we evaluated subsequent visits to look for documentation of resolution of symptoms and follow up radiography at 6 weeks and 12 months from index hospitalization.

•  Current guidelines from American medical societies, do not support routine radiographic follow up after initial diagnosis of pneumonia in the general population. In few studies, the incidence of a new diagnosis after repeat imaging is about 5.2%, most of the times correlation with a non malignant diagnosis.

•  No specific recommendation is made for immunocompromised

patients regarding need, time or methods for follow up after diagnosis of pneumonia.

•  The presence of persistent radiographic findings and symptoms should

prompt follow up and expand investigation. •  An important risk associated with transplantation is a potential

increased rate of solid organ tumors after solid organ transplantation. •  The limitations of our study includes selection of patients based on

discharge codes, information based on available documentation, small sample, narrow follow up period and limited to the Henry Ford Health System.

Follow Up Imaging After Diagnosis of Pneumonia in Solid Organ Transplant Recipients

Odaliz Abreu Lanfranco, MD1 Mo Shirur2, Mayur Ramesh MD1, Ramon del Busto1 George Alangaden MD1,2

1 Henry Ford Health System, Detroit, Michigan .

N=39  

39 patients diagnosed with pneumonia

Follow up imaging within 3 months

27 patients (69%) •  Chest radiograph (22 patients) •  CT Scan of chest (5 patients)

12 patients (31%)

YES NO

Resolution of radiographic images in 21 cases

Non resolving findings: •  Calcified granulomas (2) •  Persistent effusion (1) •  Resolving pneumonia (2) •  Pulmonary nodule(1)

At one year: 2 patients diagnosed

with neoplasms: Lung squamous cell carcinoma and Post-transplant

lymphoproliferative disease (PTLD)

After 6 weeks, one patient was diagnosed with pulmonary

Aspegillosis