Chest

Chest

Volume 112, Issue 4, October 1997, Pages 924-930
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Clinical Investigations: Lung Transplantation
Infections in Patients With Cystic Fibrosis Following Lung Transplantation

https://doi.org/10.1378/chest.112.4.924Get rights and content

Background

There is controversy over whether colonization with drug-resistant organisms is a contraindication to lung transplantation.

Methods

We undertook a retrospective review of the results of lung transplantation for patients with cystic fibrosis (CF) at Duke University Medical Center.

Results

As of May 1996, 21 patients with CF underwent bilateral lung transplantation. The first patient died within 24 h of transplantation from sepsis due to Stenotrophomonas maltophilia. Of the remaining 20 patients, 17 (85%) are alive and in stable condition. The three deaths were related primarily to bronchiolitis obliterans at 4 and 18 months in two patients and to cytomegalovirus pneumonitis at 5 months in the other patient. The 17 surviving patients have been followed up for a mean of 13 months (range, 0.5 to 34 months). Most of them were colonized and infected with multidrug-resistant organisms before transplantation. Following transplantation, 11 patients had complications from infections. One patient had bacteremia due to a panresistant Burkholderia cepacia and was treated successfully. Two patients had bacteremia and wound infection due to Burkholderia gladioli, previously thought to be pathogenic only in plants. Both patients were treated successfully. Of the six patients with Aspergillus fumigatus isolated from cultures before transplantation, only one had invasive disease following transplantation and responded to treatment.

Conclusion

The organisms present before transplantation were not the primary cause of mortality in our patient population. Our findings suggest that lung transplantation should be considered in CF patients infected with multidrug-resistant organisms.

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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    Copyright © 1997 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.