Pulmonary transplantation for cystic fibrosis: pre-transplant recipient characteristics in patients dying of peri-operative sepsis.
BACKGROUND
Pulmonary transplantation has emerged as a successful treatment for end-stage cystic fibrosis. Despite the chronic bronchial sepsis and often multi-resistant organisms seen in this group of recipients, death due to post-operative sepsis is relatively scarce. Identifying potential recipient risk factors for poor outcome may further improve the utilization of a scarce donor pool.


METHODS
We assessed the role of pre-operative clinical measures of sepsis, microbial characteristics and recipient characteristics on post-transplant outcome in 85 cystic fibrosis patients who underwent pulmonary transplantation. Ten percent of patients died in the early post-operative period due to sepsis. The prognostic role of recipient factors including markers of sepsis, such as white cells and C-reactive protein (CRP), and the influence of multi-resistant organisms, in particular organisms from the Burkholderia cepacia complex, on outcomes were investigated.


RESULTS
We found no prognostic effect of gender, pre-transplant CRP, forced expiratory volume in 1 second (FEV(1)), weight, diabetic status or infection with multi-resistant Pseudomonas organisms. A raised white cell count or temperature or a pre-transplant infection with B cepacia was, however, associated with a significantly poorer prognosis at p = 0.03, 0.03 and 0.001, respectively.


CONCLUSIONS
Pre-operative B cepacia complex infection, leukocytosis and pyrexia, but not CRP, weight, diabetes or lung function, were found to be associated with poorer post-transplant outcome. The most clinically relevant of these to the subsequent risk of post-operative death from sepsis appear to be B cepacia infection and pyrexia.
De Soyza
Anthony
A
Lung Transplantation and Biology, The Freeman Hospital, University of Newcastle, Newcastle, UK. anthony.de-sozya@ncl.ac.uk
Archer
Linda
L
Wardle
J
J
Parry
Gareth
G
Dark
John H
JH
Gould
Kate
K
Corris
Paul A
PA
D015415:Biomarkers / Q000097:blood; D001831:Body Temperature; D019121:Burkholderia Infections / Q000378:metabolism / Q000382:microbiology / Q000401:mortality; D042602:Burkholderia cepacia complex; D002097:C-Reactive Protein / Q000378:metabolism; D003550:Cystic Fibrosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007958:Leukocyte Count; D016040:Lung Transplantation / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D011237:Predictive Value of Tests; D011552:Pseudomonas Infections / Q000378:metabolism / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000378:metabolism / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom
D015415:Biomarkers; D002097:C-Reactive Protein