Clinical Outcome Following Lung Transplantation In Cystic Fibrosis Patients Colonized With Burkholderia Cepacia Complex: Results From Two French Centers

Abstract

Background: Infection with Burkholderia cepacia complex (BCC) is a life-threatening complication of cystic fibrosis (CF) often seen as a contraindication for lung transplantation.

Methods: We conducted a long-term retrospective study of all CF patients undergoing lung transplants from January 1990 to October 2006 in two French centers allowing transplantation in BCC-colonized patients.

Results: Twenty-two of the 247 lung transplant patients with CF were infected with BCC (B. cenocepacia genomovar III n=8, B. multivorans genomovar II n=11, B. vietnamiensis genomovar V n=2 and B. stabilis genomovar IV n=1). BCC colonization was not associated with any significant excess mortality (HR 1.5, 95% CI 0.7 to 3.2, p=0.58). However, early mortality rates tended to be higher in the BCC group than in the non BCC group (3-month survival: 85% vs 95%, respectively; log rank p=0.05). Univariate analysis showed that the risk of death was significantly higher for the eight patients infected with B. cenocepacia than for the other 14 colonized patients (HR 3.2, 95% CI 1.1 to 5.9, p=0.04). None of the other risk factors tested - primary graft failure, late extubation, septicemia - had a significant effect. The five-year cumulative incidence rate of bronchiolitis obliterans syndrome was not significantly higher in the BCC group than in the non BCC group (38% vs 24%, respectively, p=0.35).

Conclusion: Our results suggest that BCC infection with a non genomovar III organism may not be associated with excess mortality after lung transplantation in CF patients and should not been seen as sufficient reason to exclude lung transplantation. However, colonization with B. cenocepacia remains potentially detrimental.