Lung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: a single-center experience.

Abstract

BACKGROUND:

Pre-operative infection with organisms from the Burkholderia cepacia complex (BCC), particularly B cenocepacia, has been linked with a poorer prognosis after transplantation compared to patients with cystic fibrosis (CF) without this infection. Therefore, many transplant centers do not list these patients for transplantation.

METHODS:

We report the early and long-term results of a cohort of lung transplant recipients with CF and pre-operative BCC infection. Patients with pre-transplantation BCC infection were identified by case-note review. BCC species status was assigned by polymerase chain reaction (PCR)-based techniques. Survival rates were compared to recipients with CF without BCC infection. Survival rates in BCC subgroups were also compared, and then further analyzed pre- and post-2001, when a new immunosuppressive and antibiotic regime was introduced for such patients.

RESULTS:

Two hundred sixteen patients with CF underwent lung transplantation and 22 had confirmed pre-operative BCC infection, with 12 of these being B cenocepacia. Nine B cenocepacia-infected recipients died within the first year, and in 8 BCC sepsis was considered to be the cause of death. Despite instituting a tailored peri-operative immunosuppressive and microbiologic care approach for such patients, post-transplantation BCC septic deaths occurred frequently in those with pre-transplantation B cenocepacia infection. In contrast, recipients infected with other BCC species had significantly better outcomes, with post-transplantation survival comparable to other recipients with CF.

CONCLUSIONS:

Mortality in patients with B cenocepacia infection was unacceptably high and has led to our center no longer accepting patients with this condition onto the lung transplant waiting list. Long-term survival in the non-B cenocepacia BCC group was excellent, without high rates of acute rejection or bronchiolitis obliterans syndrome (BOS) longer term, and these patients continue to be considered for lung transplantation.

• Authors: Anthony De Soyza, Gerard Meachery, Katy L M Hester, Audrey Nicholson, Gareth Parry, Krzysztof Tocewicz, Thasee Pillay, Stephen Clark, James L Lordan, Stephan Schueler, Andrew J Fisher, John H Dark, F Kate Gould, Paul A Corris
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 29 Issue 12 Pg. 1395-404 (Dec 2010) ISSN: 1557-3117 [Electronic] United States
• PMID: 20810293 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Burkholderia Infections (drug therapy, microbiology, mortality)
• Burkholderia cenocepacia (drug effects, isolation & purification)
• Burkholderia cepacia complex (classification, drug effects, isolation & purification)
• Cause of Death
• Cohort Studies
• Cystic Fibrosis (microbiology, mortality, surgery)
• Follow-Up Studies
• Humans
• Lung Transplantation (mortality)
• Retrospective Studies
• Sepsis (mortality)
• Species Specificity
• Survival Rate
• Treatment Outcome