title: Survival after lung transplantation for cystic fibrosis in Sweden.
abstract: In Sweden, lung transplantation has been performed in patients with end-stage lung disease since 1990. We assessed survival after lung transplantation for cystic fibrosis (CF) with focus on early mortality and outcome for patients infected with certain multiresistant bacteria, considered a relative contraindication for lung transplantation.
  
  
  
  Review of CF and transplant databases and patient charts. The Kaplan-Meier method and log-rank test were used for survival analysis and group comparison.
  
  
  
  From November 1991 to December 2014, 115 transplantations were performed in 106 CF patients (9 retransplantations): 3 heart-lung, 106 double lung-, 1 double lobar- and 5 single lung transplantations, constituting 13% (115/909) of all lung-transplant procedures performed in Sweden. The mean age at surgery was 31 (SD 10, range 10-61) years and there were 48% females. Overall 1-year survival after lung transplantation for CF was 86.4%, 5-year survival was 73.7% and 10-year survival was 62.4%. The mean and median survival after transplantation were 13.1 (95% confidence interval (CI): 11-15.3) and 14.6 (95% CI: 9.3-19.8) years, respectively, and there was no significant difference for gender or transplant centre. Extracorporeal membrane oxygenation was used as a bridge to transplantation in 11 cases and five patients received reconditioned lungs. Vascular and infectious complications contributed to eight deaths within the first three postoperative months. The mean survival for 14 patients infected pretransplant with Mycobacterium abscessus or Burkholderia cepacia complex was 8.8 (95% CI: 6.1-11.6) years compared to 13.2 (95% CI: 10.9-15.8) years for patients negative for these bacteria. Nineteen patients (14% of all listed), of whom three were listed for retransplantation, died while waiting a median time of 94 days (range 4 days-2.5 years) after listing.
  
  
  
  Survival after lung transplantation in Sweden is good, also for patients with pretransplant infection with M. abscessus or B. cepacia complex, and comparable to international data.
authors.affiliation: Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Marita
authors.initials: M
authors.lastname: Gilljam
authors.affiliation: Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Nyström
authors.affiliation: Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Dellgren
authors.affiliation: Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Skog
authors.affiliation: Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Hansson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods; D019121:Burkholderia Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D016956:Burkholderia cepacia / Q000187:drug effects; D002648:Child; D000075202:Contraindications; D003550:Cystic Fibrosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D009894:Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Burkholderia cepacia complex; Cystic fibrosis; ECMO; Lung transplantation; Mycobacterium abscessus; Treatment outcome