Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Medicine, Critical care service, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Carrefour de l'innovation et santé des populations, Centre de recherche du CHUM, Montréal, Quebec, Canada.
J Heart Lung Transplant. 2023 Jul;42(7):917-924. doi: 10.1016/j.healun.2023.02.001. Epub 2023 Feb 15.
Prior infection with Burkholderia cepacia complex (BCC) has been associated with poorer outcomes after lung transplantation, posing an important dilemma for cystic fibrosis (CF). Although current guidelines consider BCC infection to be a relative contraindication, some centers continue to offer lung transplantation to BCC-infected CF patients.
We conducted a retrospective cohort study which included all consecutive CF-LTR between 2000 and 2019 to compare the postoperative survival of BCC-infected CF lung transplant recipients (CF-LTR) to BCC-uninfected patients. We used a Kaplan-Meier analysis to compare survival of BCC-infected to BCC-uninfected CF-LTR and fitted a multivariable Cox model, adjusted for age, sex, BMI and year of transplantation as potential confounders. As an exploratory analysis, Kaplan-Meier curves were also stratified by the presence of BCC and urgency of transplantation.
A total of 205 patients were included with a mean age of 30.5 years. Seventeen patients (8%) were infected with BCC prior to LT. Patients were infected with the following species: B. multivorans, B. vietnamiensis, combined B. multivorans and B. vietnamiensis and others. None of the patients were infected with B. cenocepacia. Three patients were infected with B. gladioli. One-year survival was 91.7% (188/205) for the entire cohort, 82.4% (14/17) among BCC-infected CF-LTR, and 92.5% (173/188) among BCC uninfected CF-LTR (crude HR = 2.19; 95%CI 0.99-4.85; p = 0.05). In the multivariable model, presence of BCC was not significantly associated with worse survival (adjusted HR 1.89; 95%CI 0.85-4.24; p = 0.12). In the stratified analysis for both presence of BCC and urgency of transplantation, urgency of transplantation among BCC-infected CF-LTR appeared to be associated with poorer outcome (p = 0.003 across the 4 subgroups).
Our results suggest that non-cenocepacia BCC-infected CF-LTR have comparable survival rate to BCC-uninfected CF-LTR.
先前感染伯克霍尔德菌复合群（BCC）与肺移植后较差的预后相关，这给囊性纤维化（CF）带来了重要的困境。尽管目前的指南认为 BCC 感染是相对禁忌症，但一些中心仍继续向 BCC 感染的 CF 患者提供肺移植。
我们进行了一项回顾性队列研究，该研究纳入了 2000 年至 2019 年间所有连续的 CF-LTR，以比较 BCC 感染的 CF 肺移植受者（CF-LTR）与未感染 BCC 的患者的术后生存情况。我们使用 Kaplan-Meier 分析比较了 BCC 感染的 CF-LTR 与未感染 BCC 的 CF-LTR 的生存情况，并使用多变量 Cox 模型进行了调整，以年龄、性别、BMI 和移植年份作为潜在的混杂因素。作为一项探索性分析，Kaplan-Meier 曲线也按 BCC 的存在和移植的紧急程度进行了分层。
共纳入 205 例患者，平均年龄为 30.5 岁。17 例（8%）患者在 LT 前感染了 BCC。患者感染的物种如下：B. multivorans、B. vietnamiensis、B. multivorans 和 B. vietnamiensis 混合感染以及其他感染。没有患者感染 B. cenocepacia。3 例患者感染 B. gladioli。整个队列的 1 年生存率为 91.7%（188/205），BCC 感染的 CF-LTR 为 82.4%（14/17），BCC 未感染的 CF-LTR 为 92.5%（173/188）（未校正 HR 2.19；95%CI 0.99-4.85；p=0.05）。在多变量模型中，BCC 的存在与生存率下降无关（校正 HR 1.89；95%CI 0.85-4.24；p=0.12）。在同时考虑 BCC 的存在和移植紧迫性的分层分析中，BCC 感染的 CF-LTR 中的移植紧迫性似乎与较差的预后相关（在 4 个亚组中 p=0.003）。
我们的结果表明，非 cenocepacia BCC 感染的 CF-LTR 与未感染 BCC 的 CF-LTR 的生存率相当。
