Solé Amparo, Vicente Rosario, Morant Pilar, Salavert Miguel, Santos María, Morales Pilar, Pastor Amparo
Servicio de Anestesia, Hospital Universitario La Fe, Valencia, Spain.
Med Clin (Barc). 2006 Feb 25;126(7):255-8. doi: 10.1157/13085281.
Lung transplantation is the only treatment for end-stage lung disease in patients with cystic fibrosis (CF). The presence of pathogens in the airways prior to transplantation is a risk factor for infections in the post-transplantation period; in fact, infections account for 80% of deaths within the first year. Our goal was to analyze the incidence of infectious complications in patients who underwent a lung transplantation due to cystic fibrosis.
Descriptive transversal study of CF transplanted lung patients since the beginning of the transplantation programme (1991 to September 2004). We evaluated data regarding opportunistic infections, demographical information, lung function, mortality causes and survival. We used descriptive statistics and Kaplan Meier for survival.
267 lung transplants were done, 57 were due to CF, 30 men and 27 women, with an average age of 21 years (7.8 years. The average time on waiting list was 96 days (range 1-407). 57 bilateral lung transplants, 3 heart-lung transplants and one combined liver-lung transplant were performed. All patients received triple immunosuppression (tacrolimus/cyclosporine, azathioprine and prednisone). 16 patients (28%) died: 4 in early postoperative period (7%), 5 at 6 months after transplantation, and the remaining 7 patients died several years post transplantation. Survival was 82% at one year, 76% at three years, and 65% at five years; 75% of our patients survived a mean of 3.56 years. Cytomegalovirus (CMV) infections occurred in 26% of patients and were associated with chronic rejection (p < 0.05). Purulent bronchitis was the most frequent bacterial infection: 59% of cases were caused by multiresistant pathogens. There was a 8.77% cases of B cepacia infection with 2 patients dying because of it. There were 7 cases of airway infection due to Aspergillus fumigatus, and 5 fungal invasive forms that were associated with chronic rejection (p < 0.05). Two cases of tuberculosis (Mycobacterium tuberculosis) were registered, 1 case of M. abcessus lung disease and 1 case of visceral leishmaniosis. Infectious diseases accounted for 19% of early and 12% of late mortality.
Although serious infections were seen after transplantation in our series, infectious events did not represent a high risk of postoperative mortality rate. Fungal disease was the only late relevant infectious complication, mainly associated with chronic rejections. Close CMV monitoring, and even pre-emptive antifungal therapy, are recommended for patients with chronic rejection.
