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J Heart Lung Transplant. 2010 Dec;29(12):1395-404. doi: 10.1016/j.healun.2010.06.007. Epub 2010 Sep 1.

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

Author information

1
Transplantation and Immunobiology Group, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. anthony.de-soyza@ncl.ac.uk

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.

PMID:
20810293
DOI:
10.1016/j.healun.2010.06.007
[Indexed for MEDLINE]

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