Prior infection with Burkholderia cepacia complex (BCC) has been associated with poorer outcomes after lung transplantation, posing an important dilemma for cystic fibrosis (CF). Although current guidelines consider BCC infection to be a relative contraindication, some centers continue to offer lung transplantation to BCC-infected CF patients.
We conducted a retrospective cohort study which included all consecutive CF-LTR between 2000 and 2019 to compare the postoperative survival of BCC-infected CF lung transplant recipients (CF-LTR) to BCC-uninfected patients. We used a Kaplan-Meier analysis to compare survival of BCC-infected to BCC-uninfected CF-LTR and fitted a multivariable Cox model, adjusted for age, sex, BMI and year of transplantation as potential confounders. As an exploratory analysis, Kaplan-Meier curves were also stratified by the presence of BCC and urgency of transplantation.
A total of 205 patients were included with a mean age of 30.5 years. Seventeen patients (8%) were infected with BCC prior to LT. Patients were infected with the following species: B. multivorans5, B. vietnamiensis3, combined B. multivorans and B. vietnamiensis3 and others4. None of the patients were infected with B. cenocepacia. Three patients were infected with B. gladioli. One-year survival was 91.7% (188/205) for the entire cohort, 82.4% (14/17) among BCC-infected CF-LTR, and 92.5% (173/188) among BCC uninfected CF-LTR (crude HR = 2.19; 95%CI 0.99-4.85; p = 0.05). In the multivariable model, presence of BCC was not significantly associated with worse survival (adjusted HR 1.89; 95%CI 0.85-4.24; p = 0.12). In the stratified analysis for both presence of BCC and urgency of transplantation, urgency of transplantation among BCC-infected CF-LTR appeared to be associated with poorer outcome (p = 0.003 across the 4 subgroups).
Our results suggest that non-cenocepacia BCC-infected CF-LTR have comparable survival rate to BCC-uninfected CF-LTR.
Abbreviations:BAL (Broncho-alveolar lavage), BCC (Burkholderia Cepacia Complex), BMI (Body Mass Index), CF (Cystic Fibrosis), CF-LTR (Cystic Fibrosis Lung Transplant Recipients), CI (Confidence Intervals), CMV (Cytomegalovirus)
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- Taxonomy and pathogenesis of the Burkholderia cepacia complex.Chron Respir Dis. 2005; 2: 209-217
- Clinical outcomes associated with Burkholderia Cepacia complex infection in patients with cystic fibrosis.Ann Am Thorac Soc. 2020; 17: 1542-1548
- The impact of resistant bacterial pathogens including pseudomonas aeruginosa and Burkholderia on lung transplant outcomes.Semin Respir Crit Care Med. 2021; 42: 436-448
- Successful treatment of cepacia syndrome with a combination of intravenous cyclosporin, antibiotics and oral corticosteroids.J Cyst Fibros. 2012; 11: 458-460
- Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex. Survival linked to genomovar type.Am J Respir Crit Care Med. 2001; 164: 2102-2106
- Twenty-year experience of lung transplantation at a single center: Influence of recipient diagnosis on long-term survival.J Thorac Cardiovasc Surg. 2004; 127: 1493-1501
- Impact of burkholderia infection on lung transplantation in cystic fibrosis.Am J Respir Crit Care Med. 2008; 178: 363-371
- Pseudomonas cepacia in lung transplant recipients with cystic fibrosis.Chest. 1993; 103: 466-471
- Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation.Am J Respir Crit Care Med. 2001; 163: 43-48
- Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia cepacia complex.Am J Transplant. 2008; 8: 1025-1030
- Lung transplant referral for individuals with cystic fibrosis: cystic Fibrosis Foundation consensus guidelines.J Cyst Fibros. 2019; 18: 321-333
- Lung transplantation: indications and contraindications.J Thorac Dis. 2018; 10: 4574-4587
- Consensus document for the selection of lung transplant candidates: an update from the international society for heart and lung transplantation.J Heart Lung Transplant. 2021; 40: 1349-1379
- Clinical outcome following lung transplantation in patients with cystic fibrosis colonised with Burkholderia cepacia complex: results from two French centres.Thorax. 2008; 63: 732-737
- Prevalence and clonality of Burkholderia cepacia complex genomovars in UK patients with cystic fibrosis referred for lung transplantation.Thorax. 2004; 59: 526-528
- Lung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: a single-center experience.J Heart Lung Transplant. 2010; 29: 1395-1404
- Pre-transplant factors associated with mortality after lung transplantation in cystic fibrosis: a systematic review and meta-analysis.J Cyst Fibros. 2019; 18: 407-415
- Lung transplantation for cystic fibrosis.J Heart Lung Transplant. 2020; 39: 553-560
- The Canadian cystic fibrosis registry 2020 annual data report.Cystic Fibrosis Canada, 2022
- Differentiation of Burkholderia species by PCR-restriction fragment length polymorphism analysis of the 16S rRNA gene and application to cystic fibrosis isolates.J Clin Microbiol. 1999; 37: 2201-2208
- Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia dolosa (genomovar VI).Clin Transplant. 2018; 32: e13236
- Burkholderia gladioli - a predictor of poor outcome in cystic fibrosis patients who receive lung transplants? A case of locally invasive rhinosinusitis and persistent bacteremia in a 36-year-old lung transplant recipient with cystic fibrosis.Can Respir J. 2011; 18: e64-e65
- Fatal Burkholderia gladioli infection misidentified as Empedobacter brevis in a lung transplant recipient with cystic fibrosis.Transpl Infect Dis. 2012; 14: E13-E18
- Empyema and bloodstream infection caused by Burkholderia gladioli in a patient with cystic fibrosis after lung transplantation.Pediatr Infect Dis J. 1996; 15: 637-639
- Burkholderia gladioli: five year experience in a cystic fibrosis and lung transplantation center.J Cyst Fibros. 2007; 6: 267-273
- Mediastinal abscess after lung transplantation secondary to Burkholderia gladioli infection.J Heart Lung Transplant. 2009; 28: 511-514
- Lung transplantation and survival in children with cystic fibrosis.N Engl J Med. 2007; 357: 2143-2152
- Combination antibiotic susceptibility testing to treat exacerbations of cystic fibrosis associated with multiresistant bacteria: a randomised, double-blind, controlled clinical trial.Lancet. 2005; 366: 463-471
Published online: February 14, 2023
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