title: Lung transplant for a patient with cystic fibrosis and active Burkholderia Cenocepacia pneumonia.
abstract: Lung transplant for cystic fibrosis has been considered contraindicated in patients who have Burkholderia Cenocepacia infection. A 24-year-old white woman who had cystic fibrosis presented with respiratory failure caused by B. Cenocepacia pneumonia. She was treated with broad-spectrum antibiotics and a double-lung transplant. The chest cavity and both bronchi were irrigated with 0.5% povidone-iodine solution. For immunosuppression, she received induction therapy with alemtuzumab (15 mg) and methylprednisolone and maintenance therapy with tacrolimus, mycophenolate mofetil, and prednisone (5 mg daily). Postoperative antibiotics included intravenous meropenem for 3 weeks; vancomycin for 10 days; and inhaled ceftazidime, oral trimethoprim-sulfamethoxazole, and doxycycline for several months. Follow-up at 25 months after transplant showed that chest radiographs were clear and lung function was normal. At 6 years after transplant, she was working full time and had no recurrence of infection from B. Cenocepacia. This case suggests that patients who have cystic fibrosis and active B. Cenocepacia pneumonia may be successfully treated with a lung transplant.
authors.affiliation: From the University of Torino, Department of Surgical Sciences, Torino, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.forename: Joseph
authors.initials: J
authors.lastname: Pilewski
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019121:Burkholderia Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D057508:Burkholderia cenocepacia / Q000302:isolation & purification*; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012121:Respiration, Artificial; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents