Original clinical scienceLung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: A single-center experience
Section snippets
Case review
A retrospective review was performed of the lung transplantation database at the Freeman Hospital, from 1989 (program start) to the present date. Case notes and microbiology results for all transplant recipients with CF, including adults and children, were examined. Clinical progress from charts and case notes was recorded.
Peri-transplantation management
All BCC-infected patients underwent bilateral lung transplantation via bilateral thoracotomy (clamshell) incisions with bilateral apical and basal chest drains. Initially,
BCC genomovar status of recipients
A total of 216 patients with CF underwent lung transplantation. Microbiology culture and genetic techniques confirmed pre-transplantation infection with BCC genomovars in 22 recipients (10% of the transplant cohort; Table 1a, Table 1b, Table 2).
None of the patients identified with BCC infections developed de novo infection post-transplantation. Pre-transplantation (i.e., at transplant listing assessment), day-of-transplantation and multiple post-transplantation isolates were analyzed. All
Discussion
Collectively, our cohort of 22 patients, including those with B cenocepacia and other BCC genomovars, did not show statistically significantly poorer survival than the non–BCC-infected cohort of CF recipients. However, when sub-analyzed, there were clearly poorer outcomes among those with pre-transplantation B cenocepacia infection. The outcomes in this subset of patients are unacceptably poor, leading to the decision to discontinue listing them for lung transplantation.
The emergence of BCC
Disclosure statement
The first two authors (A.D.S. and G.M.) contributed equally to this study. A.D.S. was supported by the Breathe North Branch of the British Lung Foundation and a HEFCE Senior Lectureship. The authors are grateful to Professor J. Govan, University of Edinburgh, for helping to perform the pulsed-field gel electrophoresis experiments referred to in this study, as previously published in Thorax 2004;59(6):526-8. We also thank the transplant coordinators and administrative staff for their support in
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