Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA.
Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA.
Clin Transplant. 2018 May;32(5):e13236. doi: 10.1111/ctr.13236.
Cystic fibrosis (CF) with severe lung disease is a well-recognized indication for lung transplantation. Colonization with various organisms in CF patients may impact post-transplant morbidity and mortality. Burkholderia cepacia complex (BCC) is made up of distinct genomovars with significant morbidity and mortality associated with B. cenocepacia (genomovar III) following lung transplant. The outcomes of patients infected with genomovar B. dolosa (genomovar VI) have yet to be described in the literature. We performed a retrospective chart review of all cystic fibrosis patients colonized with B. dolosa from our center who underwent lung transplantation (n = 11) at various medical centers across the US between 2000 and 2014. Survival rates were 73%, 53%, and 30% for 1, 3, and 5 years, respectively. Median survival was 44 months (95% CI = 11.1-76.8). CF patients with B. dolosa that have undergone lung transplantation have decreased one-year survival when compared to all patients transplanted with cystic fibrosis. Conditional 5-year survival for B. dolosa-infected patients was 43% in patients that survived the first year post-transplant, suggesting that this first year is crucial in managing the infection. Importantly, the survival of the B. dolosa patients was higher than compared to previously reported survival rates of B. cenocepacia patients post-transplant.
囊性纤维化(CF)合并严重肺部疾病是肺移植的明确适应证。CF 患者定植的各种生物体可能会影响移植后的发病率和死亡率。洋葱伯克霍尔德菌复合群(BCC)由不同的基因变种组成,B. cepacia(基因变种 III)定植与肺移植后发病率和死亡率显著相关。B. 多洛萨(基因变种 VI)定植患者的预后尚未在文献中描述。我们对 2000 年至 2014 年间在美国各地的多个医疗中心接受肺移植的、定植有 B. 多洛萨的 CF 患者(n=11)进行了回顾性图表审查。1、3 和 5 年的生存率分别为 73%、53%和 30%。中位生存时间为 44 个月(95%CI=11.1-76.8)。与所有接受肺移植的 CF 患者相比,B. 多洛萨定植的 CF 患者的 1 年生存率降低。在第一年移植后存活的 B. 多洛萨感染患者中,5 年条件生存率为 43%,这表明第一年的管理对于控制感染至关重要。重要的是,与先前报道的 B. cepacia 患者移植后生存率相比,B. 多洛萨患者的生存率更高。