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Pulmonary transplantation for cystic fibrosis: Pre-transplant recipient characteristics in patients dying of peri-operative sepsis

Lookup NU author(s): Professor Anthony De Soyza, Dr Josephine Wardle, Professor John Dark, Professor Paul Corris

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Abstract

Background: Pulmonary transplantation has emerged as a successful treatment for end-stage cystic fibrosis. Despite the chronic bronchial sepsis and often multi-resistant organisms seen in this group of recipients, death due to post-operative sepsis is relatively scarce. Identifying potential recipient risk factors for poor outcome may further improve the utilization of a scarce donor pool. Methods: We assessed the role of pre-operative clinical measures of sepsis, microbial characteristics and recipient characteristics on post-transplant outcome in 85 cystic fibrosis patients who underwent pulmonary transplantation. Ten percent of patients died in the early post-operative period due to sepsis. The prognostic role of recipient factors including markers of sepsis, such as white cells and C-reactive protein (CRP), and the influence of multi-resistant organisms, in particular organisms from the Burkholderia cepacia complex, on outcomes were investigated. Results: We found no prognostic effect of gender, pre-transplant CRP, forced expiratory volume in 1 second (FEV1), weight, diabetic status or infection with multi-resistant Pseudomonas organisms. A raised white cell count or temperature or a pre-transplant infection with B cepacia was, however, associated with a significantly poorer prognosis at p = 0.03, 0.03 and 0.001, respectively. Conclusions: Pre-operative B cepacia complex infection, leukocytosis and pyrexia, but not CRP, weight, diabetes or lung function, were found to be associated with poorer post-transplant outcome. The most clinically relevant of these to the subsequent risk of post-operative death from sepsis appear to be B cepacia infection and pyrexia.


Publication metadata

Author(s): Dark JH; De Soyza A; Corris PA; Wardle J; Archer L; Parry G; Gould K

Publication type: Article

Publication status: Published

Journal: Journal of Heart and Lung Transplantation

Year: 2003

Volume: 22

Issue: 7

Pages: 764-769

ISSN (print): 1053-2498

ISSN (electronic): 1557-3117

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/S1053-2498(02)00641-1

DOI: 10.1016/S1053-2498(02)00641-1

PubMed id: 12873544


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