Background
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.
Methods
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.
Results
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).
Conclusion
Our results suggest that non-cenocepacia BCC-infected CF-LTR have comparable survival rate to BCC-uninfected CF-LTR.
KEYWORDS
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)To read this article in full you will need to make a payment
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Publication history
Published online: February 14, 2023
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