title: Epidemic Pseudomonas aeruginosa infection in patients with cystic fibrosis is not a risk factor for poor clinical Outcomes following lung transplantation.
abstract: Epidemic strains of Pseudomonas aeruginosa (ePA) causing infection in cystic fibrosis (CF) have been commonly identified from clinics around the world. ePA disproportionally impacts CF patient pre-transplant outcomes manifesting in increased exacerbation frequency, worsened treatment burden and increased rate of lung function decline, and disproportionally leads to death and/or transplantation. As other CF factors such as pre-transplant infection with multi-resistant organisms, and isolation of P. aeruginosa in the post transplant graft, may impact post-transplant outcomes, we sought to determine if infection with ePA similarly adversely impact post-transplant outcomes.
  
  
  
  Between 1991-2014, 53 CF patients from our center received lung transplants. Bacterial strain typing was performed retrospectively on isolates collected prior to transplantation. Comprehensive chart reviews were performed to obtain baseline patient characteristics and post-transplant outcomes.
  
  
  
  Of the 53 transplanted patients, 57% of patients were infected with ePA prior to transplant; the other 43% of patients had unique strains of P. aeruginosa. Mean age at transplant was 29.0years for ePA and 33.3years for unique (p=0.04). There were no differences in overall survival (HR=0.75, 95% CI 0.31-1.79), bronchiolitis obliterans syndrome (BOS) free survival (HR 1.43, 95% CI 0.54-4.84) or all other assessed outcomes including exacerbation frequency, chronic renal failure, acute cellular rejections, Aspergillus infection, airway stenosis, and post-transplant lymphoproliferative disorder.
  
  
  
  Unlike pre-transplant outcomes, CF patients infected with ePA do not experience worse post-transplant outcomes than those infected with unique strains. Therefore, lung transplantation should be considered for all patients with P. aeruginosa infection and end stage lung disease, irrespective of infection with ePA.
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Pritchard
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Mitesh V
authors.initials: MV
authors.lastname: Thakrar
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Ranjani
authors.initials: R
authors.lastname: Somayaji
authors.affiliation: Department of Biochemistry, and the Farncombe Family Digestive Health Research Institute, McMaster University, 1280 Main Street West, Hamilton ON L8S 4L8, Canada; Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Surette
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Harvey R
authors.initials: HR
authors.lastname: Rabin
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Helmersen
authors.affiliation: Department of Medicine, The University of Alberta, 8440 112 Street, Edmonton, AB T6G 2B7, Canada.
authors.forename: Dale
authors.initials: D
authors.lastname: Lien
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Swathi
authors.initials: S
authors.lastname: Purighalla
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Waddell
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada. Electronic address: mdparkin@ucalgary.ca.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Parkins
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000145:classification / Q000302:isolation & purification; D018570:Risk Assessment; D012307:Risk Factors; D012703:Serotyping / Q000379:methods; D016019:Survival Analysis
keywords: Bronchiectasis; Liverpool epidemic strain; Multi-drug resistant; Prairie Epidemic Strain; Transmissible; Transplant