Infectious complications of lung transplantation. Impact of cystic fibrosis.
It has been suggested that the presence of airway pathogens prior to lung transplantation (LT) in patients with cystic fibrosis (CF) may place these patients at a higher risk for infectious complications after LT. There is particular concern regarding patients colonized with multiresistant Pseudomonas, including P. cepacia, and fungi, including Aspergillus. We report our experience with LT for patients with CF and compare the results with those of patients with LT for other indications. Between January 1990 and March 1993, we performed LT for 27 patients with CF and 32 without CF. Nearly all (89%) of the patients with CF were colonized with P. aeruginosa; many were cultured with P. cepacia (19%) and Aspergillus (63%). The non-CF group rarely had organisms identified pre-LT. No patients with CF underwent pre-LT sinus drainage or received pre-LT treatment for Aspergillus. All of the patients received perioperative antibiotics and a standard regimen of immunosuppression and prophylactic antibiotics. The incidence of infectious complications was the same in the two groups; however, there was an association between obliterative bronchiolitis and pulmonary infections. One of the patients with CF with P. cepacia died as a result of this organism. None of the patients with CF required treatment for Aspergillus post-transplant. We conclude that patients with CF, despite the presence of airway pathogens, are at no greater risk of infectious complications after LT than are other patients.
Flume
P A
PA
Department of Medicine, University of North Carolina at Chapel Hill.
Egan
T M
TM
Paradowski
L J
LJ
Detterbeck
F C
FC
Thompson
J T
JT
Yankaskas
J R
JR
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D001989:Bronchiolitis Obliterans / Q000150:complications; D016956:Burkholderia cepacia; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D002423:Cause of Death; D003550:Cystic Fibrosis / Q000401:mortality / Q000601:surgery*; D004352:Drug Resistance, Microbial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D011182:Postoperative Care; D011292:Premedication; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011550:Pseudomonas aeruginosa; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents