Transplantation and Immunobiology Group, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK.
J Heart Lung Transplant. 2010 Dec;29(12):1395-404. doi: 10.1016/j.healun.2010.06.007. Epub 2010 Sep 1.
Pre-operative infection with organisms from the Burkholderia cepacia complex (BCC), particularly B cenocepacia, has been linked with a poorer prognosis after transplantation compared to patients with cystic fibrosis (CF) without this infection. Therefore, many transplant centers do not list these patients for transplantation.
We report the early and long-term results of a cohort of lung transplant recipients with CF and pre-operative BCC infection. Patients with pre-transplantation BCC infection were identified by case-note review. BCC species status was assigned by polymerase chain reaction (PCR)-based techniques. Survival rates were compared to recipients with CF without BCC infection. Survival rates in BCC subgroups were also compared, and then further analyzed pre- and post-2001, when a new immunosuppressive and antibiotic regime was introduced for such patients.
Two hundred sixteen patients with CF underwent lung transplantation and 22 had confirmed pre-operative BCC infection, with 12 of these being B cenocepacia. Nine B cenocepacia-infected recipients died within the first year, and in 8 BCC sepsis was considered to be the cause of death. Despite instituting a tailored peri-operative immunosuppressive and microbiologic care approach for such patients, post-transplantation BCC septic deaths occurred frequently in those with pre-transplantation B cenocepacia infection. In contrast, recipients infected with other BCC species had significantly better outcomes, with post-transplantation survival comparable to other recipients with CF.
Mortality in patients with B cenocepacia infection was unacceptably high and has led to our center no longer accepting patients with this condition onto the lung transplant waiting list. Long-term survival in the non-B cenocepacia BCC group was excellent, without high rates of acute rejection or bronchiolitis obliterans syndrome (BOS) longer term, and these patients continue to be considered for lung transplantation.
与未感染伯克霍尔德菌复合群（BCC）的囊性纤维化（CF）患者相比，术前感染 BCC，尤其是洋葱伯克霍尔德菌，与移植后预后较差相关。因此，许多移植中心不将这些患者列入移植名单。
我们报告了一组 CF 合并术前 BCC 感染的肺移植受者的早期和长期结果。通过病历回顾识别移植前 BCC 感染患者。通过聚合酶链反应（PCR）为基础的技术确定 BCC 种属状态。将生存率与无 BCC 感染的 CF 患者进行比较。还比较了 BCC 亚组的生存率，然后进一步分析 2001 年前后的情况，当时为这些患者引入了新的免疫抑制和抗生素治疗方案。
216 例 CF 患者接受了肺移植，22 例患者术前被证实感染了 BCC，其中 12 例为洋葱伯克霍尔德菌。9 例感染洋葱伯克霍尔德菌的患者在一年内死亡，8 例 BCC 败血症被认为是死亡原因。尽管针对此类患者制定了围手术期个体化免疫抑制和微生物护理方案，但在移植后，仍经常发生 BCC 败血症死亡，尤其是那些术前感染洋葱伯克霍尔德菌的患者。相比之下，感染其他 BCC 种属的患者的预后明显更好，移植后生存率与其他 CF 患者相当。
感染洋葱伯克霍尔德菌的患者死亡率高得不可接受，导致我们中心不再将此类患者列入肺移植等候名单。非洋葱伯克霍尔德菌 BCC 组的长期生存率极佳，无急性排斥反应或闭塞性细支气管炎综合征（BOS）长期高发生率，这些患者仍被考虑进行肺移植。
