title: Impact of sinus surgery on pseudomonal airway colonization, bronchiolitis obliterans syndrome and survival in cystic fibrosis lung transplant recipients.
abstract: BACKGROUND
  Lung transplantation (LTx) is a therapy for patients with cystic fibrosis (CF) end-stage lung disease. Pseudomonal airway colonization (PAC) is common in CF.
  
  
  OBJECTIVE
  We investigated the influence of post-transplant sinus surgery and daily nasal douching on PAC after LTx and the influence of PAC on survival and bronchiolitis obliterans syndrome (BOS).
  
  
  METHODS
  CF patients transplanted at our centre were included (November 1992 to December 2009). Clinical data, including microbiological data before and after LTx were collected. Survival and BOS following LTx were compared for CF recipients with and without PAC by Kaplan-Meier statistics and Cox regression analysis.
  
  
  RESULTS
  Ninety-four CF patients were transplanted, of whom 82 (87%) underwent sinus surgery after transplantation, and 65% of 66 patients with pre-transplant PAC had persistent PAC after transplantation. Upper and lower PAC is related. Patients without PAC after transplantation had a significantly better survival rate, and BOS was less frequent with a later onset. PAC was the only significant parameter for the development of BOS stage 2 in the multivariate analysis for cytomegalovirus infection, acute rejection and PAC.
  
  
  CONCLUSIONS
  Sinus surgery and daily nasal douching reduced PAC in LTx recipients. Absence of post-transplant PAC had a positive impact on post-transplant survival and the development of BOS.
authors.affiliation: Division of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Domenic
authors.initials: D
authors.lastname: Vital
authors.forename: Markus
authors.initials: M
authors.lastname: Hofer
authors.forename: Christian
authors.initials: C
authors.lastname: Benden
authors.forename: David
authors.initials: D
authors.lastname: Holzmann
authors.forename: Annette
authors.initials: A
authors.lastname: Boehler
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000150:complications; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D003550:Cystic Fibrosis / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D055556:Nasal Lavage / Q000379:methods; D010256:Paranasal Sinuses / Q000601:surgery*; D016016:Proportional Hazards Models; D011552:Pseudomonas Infections / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome