title: Impact of graft colonization with gram-negative bacteria after lung transplantation on the development of bronchiolitis obliterans syndrome in recipients with cystic fibrosis.
abstract: Bronchiolitis obliterans syndrome (BOS) represents the leading cause of late mortality after lung transplantation (LTx). Cystic fibrosis (CF) patients frequently show airway colonization with gram-negative bacteria (GNB) both before and after LTx. Graft colonization with GNB and its relevance towards BOS development were investigated in a CF population after LTx. Adult CF patients receiving LTx and surviving at least 6 months were included in this prospective observational study between 1/1/2002 and 30/6/2006 in a single center and followed until 31/3/2007. Pre- and post-LTx respiratory culture samples were compared for the presence of identical GNB. BOS-free survival was compared in colonized and non-colonized patients. Fifty-nine adult CF patients with a median age at LTx of 25.5 (18-49) years were included and had a median follow-up of 966 (128-1889) days. Seven patients (15%) demonstrated immediate eradication of GNB in lower respiratory tract samples. A further 18 patients (34%) demonstrated transient colonization. Thirty-four recipients had further positive samples after LTx. Eighteen patients (31%) developed BOS >or=stage 1, 508 (114-1167) days after LTx. Freedom of graft colonization with pseudomonads was independently associated with less frequent development of BOS (p=0.006). Persistent graft colonization with pseudomonads increases the prevalence of BOS after LTx in CF patients. A significant proportion of post-LTx CF patients demonstrates subsequent GNB eradication during later follow-up and this may have a protective role against development of BOS. Strategies to eradicate airway colonization or reduce bacterial load may prevent BOS in CF patients after LTx.
authors.affiliation: Department of Respiratory Medicine OE6870, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. gottlieb.jens@mh-hannover.de
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
authors.forename: F
authors.initials: F
authors.lastname: Mattner
authors.forename: H
authors.initials: H
authors.lastname: Weissbrodt
authors.forename: M
authors.initials: M
authors.lastname: Dierich
authors.forename: T
authors.initials: T
authors.lastname: Fuehner
authors.forename: M
authors.initials: M
authors.lastname: Strueber
authors.forename: A
authors.initials: A
authors.lastname: Simon
authors.forename: T
authors.initials: T
authors.lastname: Welte
mesh_terms: D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000382:microbiology*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D003550:Cystic Fibrosis / Q000382:microbiology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005541:Forced Expiratory Volume; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult