Table 1a.

Bacterial Pneumonia and Colonization in CTTX

Infection	Signs/symptoms	Radiology	Microbiology/pathology	Histopathologic evidence of AR
Proven pneumonia, acute rejection (AR)- associated OR not AR associated	At least one of the following:  • Fever >38oC or hypothermia <36.5oC with no other recognized cause  • Leukopenia (<4,000 WBC/mm3) or leukocytosis (≥15,000 WBC/mm3) And at least two of the following:  • New-onset of purulent sputum OR change in character/quantity of sputum OR increased respiratory secretions suctioned  • New-onset or worsening cough, dyspnea, tachypnea, OR pleural rub, rales OR bronchial breath sounds  • Worsening gas exchange (O2 desaturations, PaO2/FIO2 ≤240, increased O2 requirements, increased ventilation demands)  • Pleural effusion	New/worsening radiographic changes on chest X-ray or CT scan	At least one of the following:  • Positive growth in blood culture unrelated to other source  • Positive growth in culture of pleural fluid  • Positive respiratory culture (sputum, bronchial secretions, BAL, bronchial protected sterile brushing)  • ≥5% BAL-obtained cells containing intracellular bacteria on direct microscopic exam	AR may be present or absent or not investigated
Probable pneumonia	As for proven	As for proven	Negative microbiology PLUS absence of AR by histopathology	AR must be excluded
Possible pneumonia	As for proven	As for proven	Microbiology negative or not performed PLUS concomitant clinical diagnosis of AR (without histopathology)	No histopathology performed
No pneumonia, proven AR	As for proven	As for proven	Negative microbiology PLUS AR proven by histopathology	Histopathologic evidence of AR
Colonization	Asymptomatic OR no significant changes in symptoms; stable PFT; normal bronchoscopy without:  • Endobronchial erythema AND  • Purulent secretions	Absent or unchanged	Recovery of pathogen in absence of clinical or radiographic changes	AR present or absent