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Survival After Lung Transplantation of Cystic Fibrosis Patients Infected with Burkholderia cepacia Complex

  1. B. D. Alexander1,*,
  2. E. W. Petzold2,
  3. L. B. Reller1,
  4. S. M. Palmer3,
  5. R. D. Davis,
  6. C. W. Woods1,
  7. J. J. LiPuma4

Article first published online: 3 MAR 2008

DOI: 10.1111/j.1600-6143.2008.02186.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 8, Issue 5, pages 1025–1030, May 2008

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How to Cite

Alexander, B. D., Petzold, E. W., Reller, L. B., Palmer, S. M., Davis, R. D., Woods, C. W. and LiPuma, J. J. (2008), Survival After Lung Transplantation of Cystic Fibrosis Patients Infected with Burkholderia cepacia Complex. American Journal of Transplantation, 8: 1025–1030. doi: 10.1111/j.1600-6143.2008.02186.x

Author Information

  1. 1

    Division of Infectious Diseases and International Health

  2. 2

    Duke Human Vaccine Institute

  3. 3

    Division of Pulmonary and Critical Care Medicine, Department of Medicine and Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC

  4. 4

    Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI

* * Corresponding author: Barbara D. Alexander, alexa011@mc.duke.edu

Publication History

  1. Issue published online: 14 APR 2008
  2. Article first published online: 3 MAR 2008
  3. Received 16 August 2007, revised 4 December 2007 and accepted for publication 18 January 2008

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Keywords:

  • Bacterial infection;
  • lung transplantation;
  • transplant infectious diseases;
  • transplant outcome

Survival following lung transplantation was compared among cystic fibrosis patients infected with Burkholderia cepacia complex (Bcc) prior to transplant and infection with Bcc species other than B. cenocepacia did not significantly impact 5 year survival, whereas infection with B. cenocepacia was associated with decreased survival

Within the Burkholderia cepacia complex (Bcc), B. cenocepacia portends increased mortality compared with other species. We investigated the impact of Bcc infection on mortality and re-infection following lung transplant (LT). Species designation for isolates from Bcc-infected patients was determined using 16S rDNA and recA gene analyses. Of 75 cystic fibrosis patients undergoing LT from September 1992 to August 2002, 59 had no Bcc and 16 had Bcc (including 7 B. cenocepacia) isolated in the year before LT. Of the latter, 87.5% had Bcc recovered after transplantation, and all retained their pretransplant strains. Survival was 97%, 92%, 76% and 63% for noninfected patients; 89%, 89%, 67% and 56% for patients infected with Bcc species other than B. cenocepacia; and 71%, 29%, 29% and 29% for patients with B. cenocepacia (p = 0.014) at 1 month, 1 year, 3 years and 5 years, respectively. Patients infected with B. cenocepacia before transplant were six times more likely to die within 1 year of transplant than those infected with other Bcc species (p = 0.04) and eight times than noninfected patients (p < 0.00005). Following LT, infection with Bcc species other than B. cenocepacia does not significantly impact 5-year survival whereas infection with B. cenocepacia pretransplant is associated with decreased survival.

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