Aris R M, Routh J C, LiPuma J J, Heath D G, Gilligan P H
Division of Pulmonary Medicine, the Department of Medicine, The University of North Carolina at Chapel Hill School of Medicine, NC 27599-7524, USA.
Am J Respir Crit Care Med. 2001 Dec 1;164(11):2102-6. doi: 10.1164/ajrccm.164.11.2107022.
The number of cystic fibrosis (CF) patients undergoing lung transplant has risen over the past decade, because of a clear-cut survival benefit. However, patients with Burkholderia cepacia complex are often excluded from transplantation because of increased mortality. To determine the influence of B. cepacia complex genomovar type on transplant outcome, we undertook a retrospective study in 121 CF patients transplanted at UNC. Twenty-one and three patients, respectively, were infected pre- or postoperatively with B. cepacia complex. All posttransplant acquisitions were successfully treated. However, excess mortality occurred over the first 6 postoperative months in those infected preoperatively with B. cepacia complex compared with those not infected (33% versus 12%, p = 0.01). The 1-, 3-, and 5-yr survival were significantly lower in the B. cepacia complex cohort. Of the patients infected preoperatively, genomovar III patients were at the highest risk of B. cepacia complex-related mortality (5 of 12 versus 0 of 8, one isolate not typed; p = 0.035). Each of the B. cepacia complex-related deaths was caused by a unique genotype as determined by pulsed-field gel electrophoresis. All isolates were negative for the cable pilin gene. These results warrant a multicenter analysis of B. cepacia complex-infected patients with genomovar-typing to confirm that genomovar III patients are at highest risk for post-transplant complications.
在过去十年中，由于肺移植对囊性纤维化（CF）患者有明确的生存益处，接受肺移植的CF患者数量有所增加。然而，洋葱伯克霍尔德菌复合体感染的患者往往因死亡率增加而被排除在移植之外。为了确定洋葱伯克霍尔德菌复合体基因变种类型对移植结果的影响，我们对在北卡罗来纳大学接受移植的121例CF患者进行了一项回顾性研究。分别有21例和3例患者在术前或术后感染了洋葱伯克霍尔德菌复合体。所有移植后感染均得到成功治疗。然而，与未感染的患者相比，术前感染洋葱伯克霍尔德菌复合体的患者在术后前6个月出现了额外的死亡（33%对12%，p = 0.01）。洋葱伯克霍尔德菌复合体组的1年、3年和5年生存率显著较低。在术前感染的患者中，基因变种III型患者发生与洋葱伯克霍尔德菌复合体相关死亡的风险最高（12例中的5例对8例中的0例，1株未分型；p = 0.035）。通过脉冲场凝胶电泳确定，每例与洋葱伯克霍尔德菌复合体相关的死亡均由独特的基因型引起。所有分离株的电缆菌毛基因均为阴性。这些结果需要对感染洋葱伯克霍尔德菌复合体的患者进行基因变种分型的多中心分析，以确认基因变种III型患者移植后并发症的风险最高。
