title: Effect of infection with transmissible strains of Pseudomonas aeruginosa on lung transplantation outcomes in patients with cystic fibrosis.
abstract: BACKGROUND
  Compared with patients infected with unique strains of Pseudomonas aeruginosa, patients with cystic fibrosis who are infected with transmissible strains of P aeruginosa, such as the Liverpool epidemic strain, have a 3-fold greater risk of death or lung transplant. We aimed to determine if pre-operative infection with transmissible strains of P aeruginosa was similarly associated with poor health outcomes after lung transplant.
  
  
  METHODS
  We had prospectively identified and characterized endobronchial infections in 446 adult cystic fibrosis patients in Ontario, Canada, from September 2005 until December 2009. P aeruginosa isolated from sputum taken at 3-month intervals was genotyped, and patients were characterized as being infected with 1 of 2 transmissible strains or, alternatively, with unique strains of P aeruginosa. We monitored patients until 2013 and collected data on patients from the cohort who subsequently received a lung transplant. The primary outcome was survival after transplantation.
  
  
  RESULTS
  We identified 56 lung transplant recipients from the cohort of 446 patients, including 18 infected with transmissible strains of P aeruginosa and 26 infected with unique P aeruginosa strains. Post-transplant survival at 3 years was 86% in the transmissible group and 84% in the unique group (p = 0.65). No significant differences between groups were found regarding bronchiolitis obliterans-free survival, the frequency of acute rejection episodes, the frequency of post-transplant respiratory tract infection, or the rate of change of post-transplant forced expiratory volume in 1 second.
  
  
  CONCLUSIONS
  Pre-operative infection with transmissible strains of P aeruginosa is not associated with poorer post-transplant outcomes compared with patients infected with unique strains of P aeruginosa.
authors.affiliation: Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada; Faculty of Medicine, McGill University, Montréal, Québec, Canada; Division of Pulmonology, Department of Medicine, Hôpital Charles-LeMoyne, Greenfield Park, Québec, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Mount Sinai Hospital Centre, Montréal, Québec, Canada. Electronic address: nadim.srour@usherbrooke.ca.
authors.forename: Nadim
authors.initials: N
authors.lastname: Srour
authors.affiliation: Toronto Lung Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada; Adult Cystic Fibrosis Clinic St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Vandemheen
authors.affiliation: Toronto Lung Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada.
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.affiliation: Toronto Lung Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D057234:Preoperative Period; D011552:Pseudomonas Infections / Q000150:complications* / Q000635:transmission*; D011550:Pseudomonas aeruginosa / Q000145:classification* / Q000472:pathogenicity; D016896:Treatment Outcome
keywords: Liverpool epidemic strain; Pseudomonas aeruginosa; cystic fibrosis; health outcomes; lung transplant; preoperative infection