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

Lookup NU author(s): Professor Anthony De Soyza, Dr Gerard Meachery, Dr Katy Hester, Anne Nicholson, T Pillay, Stephen Clark, Dr James Lordan, Dr Stephan Schueler, Professor Andrew Fisher, Professor John Dark, Professor Kate Gould, Professor Paul Corris

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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 pen 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 bronchrolitis obliterans syndrome (BOS) longer term and these patients continue to be considered for lung transplantation J Heart Lung Transplant 2010 29 1395-1404 (C) 2010 International Society for Heart and Lung Transplantation All rights reserved


Publication metadata

Author(s): De Soyza A, Meachery G, Hester KLM, Nicholson A, Parry G, Tocewicz K, Pillay T, Clark S, Lordan JL, Schueler S, Fisher AJ, Dark JH, Gould FK, Corris PA

Publication type: Article

Publication status: Published

Journal: Journal of Heart and Lung Transplantation

Year: 2010

Volume: 29

Issue: 12

Pages: 1395-1404

Print publication date: 01/09/2010

ISSN (print): 1053-2498

ISSN (electronic): 1557-3117

Publisher: Elsevier Inc.

URL: http://dx.doi.org/10.1016/j.healun.2010.06.007

DOI: 10.1016/j.healun.2010.06.007


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