Am. J. Respir. Crit. Care Med., Volume 163, Number 1, January 2001, 43-48

Infection with Burkholderia cepacia in Cystic Fibrosis
Outcome Following Lung Transplantation

CECILIA CHAPARRO, JANET MAURER, CARLOS GUTIERREZ, MEL KRAJDEN, CHARLIE CHAN, TIMOTHY WINTON, SHAFF KESHAVJEE, MASSINA SCAVUZZO, ELIZABETH TULLIS, MICHAEL HUTCHEON, and STEVEN KESTEN

Toronto Lung Transplant Program, Toronto Hospital, University of Toronto, Toronto, Ontario, Canada; Cleveland Clinic, Cleveland, Ohio; Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut; and Adult Cystic Fibrosis Clinic, Wellesley Hospital, Toronto, Ontario, Canada

As a result of concern over excessive mortality after lung transplantation, many transplant programs refuse to accept cystic fibrosis (CF) patients infected with Burkholderia cepacia. As a significant proportion of patients with CF in our community are infected with this organism, we have continued to provide lung transplantation as an option. A retrospective review was conducted of medical records of all patients with CF transplanted between March 1988 and September 1996. Fifty-six transplant procedures were performed in 53 recipients with CF between March 1988 and September 1996. Twenty-eight had B. cepacia isolated pretransplant and 25 remaining positive post-transplant. Of the 53 recipients, 19 have died (15 of 28 [54%] B. cepacia positive and 4 of 25 [16%] B. cepacia negative). B. cepacia was responsible for or involved in 14 deaths. Nine of the deaths occurred in the first 3 mo post-transplantation. One-year survival was 67% for B. cepacia positive patients and 92% for B. cepacia negative patients. Recent modifications in antimicrobial and immunosuppressive therapy since 1995 have resulted in no deaths early post-transplant in the last five patients transplanted. We conclude that early mortality in patients with CF infected with B. cepacia is significantly higher than in those not infected with B. cepacia. Modifications in post-transplant medical therapy may improve outcome.

This article has been cited by other articles:

				A. De Soyza, A. Silipo, R. Lanzetta, J. R. Govan, and A. Molinaro Review: Chemical and biological features of Burkholderia cepacia complex lipopolysaccharides Innate Immunity, June 1, 2008; 14(3): 127 - 144. [Abstract] [PDF]

				J. E. Ollech, M. R. Kramer, N. Peled, A. Ollech, A. Amital, B. Medalion, M. Saute, and D. Shitrit Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 844 - 848. [Abstract] [Full Text] [PDF]

				S. C Bell and P. J Robinson Exacerbations in cystic fibrosis: 2 {middle dot} Prevention Thorax, August 1, 2007; 62(8): 723 - 732. [Abstract] [Full Text] [PDF]

				D. Hadjiliadis Special Considerations for Patients With Cystic Fibrosis Undergoing Lung Transplantation Chest, April 1, 2007; 131(4): 1224 - 1231. [Abstract] [Full Text] [PDF]

				J. L. Taylor and S. M. Palmer Critical Care Perspective on Immunotherapy in Lung Transplantation J Intensive Care Med, December 1, 2006; 21(6): 327 - 344. [Abstract] [PDF]

				J S Elborn Practical Management of Cystic Fibrosis Chronic Respiratory Disease, July 1, 2006; 3(3): 161 - 165. [PDF]

				R.-P. Vonberg, S. Haussler, P. Vandamme, and I. Steinmetz Identification of Burkholderia cepacia complex pathogens by rapid-cycle PCR with fluorescent hybridization probes J. Med. Microbiol., June 1, 2006; 55(6): 721 - 727. [Abstract] [Full Text] [PDF]

				S. Campana, G. Taccetti, N. Ravenni, F. Favari, L. Cariani, A. Sciacca, D. Savoia, A. Collura, E. Fiscarelli, G. De Intinis, et al. Transmission of Burkholderia cepacia Complex: Evidence for New Epidemic Clones Infecting Cystic Fibrosis Patients in Italy J. Clin. Microbiol., October 1, 2005; 43(10): 5136 - 5142. [Abstract] [Full Text] [PDF]

				T. G. Liou, F. R. Adler, and D. Huang Use of Lung Transplantation Survival Models to Refine Patient Selection in Cystic Fibrosis Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 1053 - 1059. [Abstract] [Full Text] [PDF]

				B. Fauroux, N. Hart, S. Belfar, M. Boule, I. Tillous-Borde, D. Bonnet, E. Bingen, and A. Clement Burkholderia cepacia Is Associated with Pulmonary Hypertension and Increased Mortality among Cystic Fibrosis Patients J. Clin. Microbiol., December 1, 2004; 42(12): 5537 - 5541. [Abstract] [Full Text] [PDF]

				G.B. Mallory and T.L. Spray Paediatric lung transplantation Eur. Respir. J., November 1, 2004; 24(5): 839 - 845. [Abstract] [Full Text] [PDF]

				A M Jones, M E Dodd, J R W Govan, V Barcus, C J Doherty, J Morris, and A K Webb Burkholderia cenocepacia and Burkholderia multivorans: influence on survival in cystic fibrosis Thorax, November 1, 2004; 59(11): 948 - 951. [Abstract] [Full Text] [PDF]

				A De Soyza, K Morris, A McDowell, C Doherty, L Archer, J Perry, J R W Govan, P A Corris, and K Gould Prevalence and clonality of Burkholderia cepacia complex genomovars in UK patients with cystic fibrosis referred for lung transplantation Thorax, June 1, 2004; 59(6): 526 - 528. [Abstract] [Full Text] [PDF]

				S. M. Levine A Survey of Clinical Practice of Lung Transplantation in North America Chest, April 1, 2004; 125(4): 1224 - 1238. [Abstract] [Full Text] [PDF]

				F. Venuta, S. Quattrucci, E. A. Rendina, T. De Giacomo, E. Mercadante, M. Moretti, G. Cimino, and G. F. Coloni Improved results with lung transplantation for cystic fibrosis: a 6-year experience Interactive CardioVascular and Thoracic Surgery, March 1, 2004; 3(1): 21 - 24. [Abstract] [Full Text] [PDF]

				R.M. Kotloff and V.N. Ahya Medical complications of lung transplantation Eur. Respir. J., February 1, 2004; 23(2): 334 - 342. [Abstract] [Full Text] [PDF]

				W. G. Veloira, P. Domenico, J. J. LiPuma, J. M. Davis, E. Gurzenda, and J. A. Kazzaz In vitro activity and synergy of bismuth thiols and tobramycin against Burkholderia cepacia complex J. Antimicrob. Chemother., December 1, 2003; 52(6): 915 - 919. [Abstract] [Full Text] [PDF]

				A.R. Glanville and M. Estenne Indications, patient selection and timing of referral for lung transplantation Eur. Respir. J., November 1, 2003; 22(5): 845 - 852. [Abstract] [Full Text] [PDF]

				M. B. Miller and P. H. Gilligan Laboratory Aspects of Management of Chronic Pulmonary Infections in Patients with Cystic Fibrosis J. Clin. Microbiol., September 1, 2003; 41(9): 4009 - 4015. [Full Text] [PDF]

				M. E. Stryjewski, J. J. LiPuma, R. H. Messier Jr., L. B. Reller, and B. D. Alexander Sepsis, Multiple Organ Failure, and Death Due to Pandoraea pnomenusa Infection after Lung Transplantation J. Clin. Microbiol., May 1, 2003; 41(5): 2255 - 2257. [Abstract] [Full Text] [PDF]

				M. Gilljam, C. Chaparro, E. Tullis, C. Chan, S. Keshavjee, and M. Hutcheon GI Complications After Lung Transplantation in Patients With Cystic Fibrosis Chest, January 1, 2003; 123(1): 37 - 41. [Abstract] [Full Text] [PDF]

				N. Mayer-Hamblett, M. Rosenfeld, J. Emerson, C. H. Goss, and M. L. Aitken Developing Cystic Fibrosis Lung Transplant Referral Criteria Using Predictors of 2-Year Mortality Am. J. Respir. Crit. Care Med., December 15, 2002; 166(12): 1550 - 1555. [Abstract] [Full Text] [PDF]

				T.M. Egan, F.C. Detterbeck, M.R. Mill, M.S. Bleiweis, R. Aris, L. Paradowski, G. Retsch-Bogart, and B.S. Mueller Long term results of lung transplantation for cystic fibrosis Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 602 - 609. [Abstract] [Full Text] [PDF]

				G J Bellingan The pulmonary physician in critical care * 6: The pathogenesis of ALI/ARDS Thorax, June 1, 2002; 57(6): 540 - 546. [Abstract] [Full Text] [PDF]

				A. F. Pierre, Y. Sekine, M. A. Hutcheon, T. K. Waddell, and S. H. Keshavjee Marginal donor lungs: A reassessment J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 421 - 428. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Pediatrics, Surfactant, and Cystic Fibrosis in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 619 - 630. [Full Text] [PDF]

				M. J. TOBIN Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 642 - 662. [Full Text] [PDF]

				R. M. ARIS, J. C. ROUTH, J. J. LIPUMA, D. G. HEATH, and P. H. GILLIGAN Lung Transplantation for Cystic Fibrosis Patients with Burkholderia cepacia Complex . Survival Linked to Genomovar Type Am. J. Respir. Crit. Care Med., December 1, 2001; 164(11): 2102 - 2106. [Abstract] [Full Text] [PDF]

				T. Coenye, P. Vandamme, J. R. W. Govan, and J. J. LiPuma Taxonomy and Identification of the Burkholderia cepacia Complex J. Clin. Microbiol., October 1, 2001; 39(10): 3427 - 3436. [Full Text] [PDF]