The outcomes of lung transplantation in patients with bronchiectasis and antibody deficiency.
BACKGROUND
Lung transplantation is an established treatment for end-stage bronchiectasis. A proportion of patients with bronchiectasis have an associated antibody deficiency. This group benefits from immunoglobulin replacement therapy, but the outcome of lung transplantation is not known.


METHODS
We conducted a retrospective observational study of all who received a transplant for bronchiectasis at our unit. We compared the survival after transplant, number of infective and rejection episodes, and the change in forced expiratory volume in 1 second (FEV1).


RESULTS
Five of the 37 patients identified with bronchiectasis had an antibody deficiency that required immunoglobulin replacement therapy. Actuarial survival was similar in the 2 groups, being 81% at 12 months in the Bronchiectasis Group and 80% in the Antibody Deficiency Group. The FEV1 at 12 months after transplantation was similar in each group, with a predicted mean +/- SD FEV1 of 83.7% +/- 24.2% in those with bronchiectasis and 83.0% +/- 30.4% in those with antibody deficiency as well. The infection and rejection rates in the first year after transplantation were lower in the Antibody Deficiency Group. Infection episodes per 100 patient-days for bronchiectasis alone were 0.90 vs 0.53 and rejection episodes per 100 patient-days were 0.59 vs 0.24.


CONCLUSIONS
There was no evidence that transplant recipients with bronchiectasis and antibody deficiency have a worse prognosis than those with bronchiectasis alone.
Nathan
James A
JA
Papworth Hospital NHS Trust, Papworth Everard, Cambridge, United Kingdom. janathan@btinternet.com
Sharples
Linda D
LD
Exley
Andrew R
AR
Sivasothy
Pasupathy
P
Wallwork
John
J
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001987:Bronchiectasis / Q000150:complications / Q000601:surgery*; D018890:Chemoprevention; D003586:Cytomegalovirus Infections / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007153:Immunologic Deficiency Syndromes / Q000150:complications / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000209:etiology / Q000628:therapy; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000935:Antifungal Agents; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents