Pseudomonas aeruginosa colonization of the allograft after lung transplantation and the risk of bronchiolitis obliterans syndrome.
Long-term survival after lung transplantation remains limited by the development of bronchiolitis obliterans syndrome (BOS). Allograft colonization with Pseudomonas aeruginosa is common particularly in recipients with BOS, but a possible etiological relationship remains unexplored. In 155 consecutive lung transplants, the development of allograft colonization with Pseudomonas was strongly associated with the development of BOS within 2 years of transplant (23.4% vs. 7.7% in those colonized and not colonized, respectively, P=0.006). Freedom from BOS was significantly shorter in those patients without any pretransplant bacterial reservoir developing de novo allograft pseudomonal colonization as compared with those remaining free of colonization (Kaplan-Meier log-rank P=0.014). The isolation of Pseudomonas preceded the diagnosis of BOS in 14 of 18 (78%) and by a median of 204 days (95% confidence interval 115-492) in patients developing both these complications. We conclude that de novo colonization of the lung allograft by Pseudomonas is strongly associated with the subsequent development of BOS.
Botha
Phil
P
Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom. P.Botha@ncl.ac.uk
Archer
Lynda
L
Anderson
Rachel L
RL
Lordan
Jim
J
Dark
John H
JH
Corris
Paul A
PA
Gould
Kate
K
Fisher
Andrew J
AJ
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous