Chest
Clinical Investigations: Lung TransplantationInfections in Patients With Cystic Fibrosis Following Lung Transplantation
Section snippets
Materials and Methods
We reviewed the records of all patients who underwent lung transplantation for CF at Duke University Medical Center. From April 1992 until May 1996, the procedure was performed on 97 patients, of whom 21 had CF. The criteria for transplantation of patients with CF included the following: life expectancy of <24 months as assessed by significant hypercarbia, increasing oxygen requirement, an FEV1 of <30% of the predicted value, and frequent hospitalizations. Exclusion criteria were the presence
Survival
Of the 21 patients with CF who underwent bilateral lung transplantation, 17 are alive and in stable condition (survival rate, 80%) at a mean follow-up of 13 months (range, 0.5 to 34.0 months). The first CF patient to undergo transplantation died within 24 h after surgery, from sepsis caused by S maltophilia. Two patients died at 4 and 18 months posttransplantation following the development of bronchiolitis obliterans: the first patient's course was complicated by invasive Aspergillus fumigatus
Discussion
Despite the recent advances in identifying the genetic cause of CF,6, 7 the use of aggressive antimicrobial therapy, and the early results of gene therapy,8, 9, 10 we are far from having a cure for this disease. Although lung transplantation is now a viable option for treating the end-stage pulmonary disease inflicted by this disorder,11, 12, 13 its use has lagged behind, in part because of the major problems attending patients with CF, problems such as nutritional deficiencies owing to
Conclusions
Despite the discovery of the CF gene, many patients with CF will continue to have recurrent pulmonary infections, which will shorten their life span. To date and to our knowledge, lung transplantation is the only therapeutic intervention that can offer these patients a second chance. New approaches with surgical techniques, advances in immunosuppressive therapy, and aggressive management of pulmonary infections have led to improving the survival and the quality of life of these patients.
ACKNOWLEDGMENT
The authors thank Pat Spivey for her editorial comments.
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