Defending B.Cepacia Transplants

B. cepacia colonization should not exclude CF patients from lung transplantation
By Will Boggs, MD
Published Online: September 16, 2008 - 1:14:32 PM (CDT)

Clinical

B. cepacia colonization should not exclude CF patients from lung transplantation

Last Updated: 2008-08-25 8:30:05 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Colonization with Burkholderia cepacia complex (BCC) should not be an automatic contraindication to lung transplantation in cystic fibrosis (CF) patients, according to a report from France in the August issue of Thorax.

"Despite recent publications, major transplantation centers are still reluctant to perform transplantation in patients infected with BCC," Dr. Veronique Boussaud from Hopital Europeen Georges Pompidou, Paris, told Reuters Health. "CF patients colonized with BCC should not be excluded from the transplantation list, unless there are other reasons."

For their study, Dr. Boussaud and colleagues retrospectively reviewed outcomes of 247 lung transplant patients with CF.

Seventeen of 22 BCC-positive patients had postoperative pulmonary specimens that tested positive for BCC, the authors report, compared with no patients without BCC infection before lung transplantation.

Overall mortality risk was similar in the BCC and non-BCC groups, the report indicates, though early mortality rates tended to be higher in the BCC group, and median survival was longer for non-BCC patients (79 months) than for BCC patients (43 months).

Patients infected with B. cenocepacia had significantly higher mortality rates than did patients infected with other strains of BCC, the researchers note.

The cumulative incidence of bronchiolitis obliterans syndrome was higher in the BCC group (38% at 5 years) than in the non-BCC group (24%), the investigators say, but the difference was not statistically significant.

"We don't think that there are effective methods to prevent any post-transplantation infection, specifically for BCC," Dr. Boussaud commented. "We showed that these colonizations didn't represent a special threat (except for cenocepacia) compared with other CF patients colonized with Pseudomonas."

While patients with cenocepacia colonization have an excess mortality in the early postoperative phase, Dr. Boussaud said, "transplantation may nevertheless still be discussed with these patients."



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