Published ahead of print on June 5, 2008, doi:10.1164/rccm.200712-1834OC Am. J. Respir. Crit. Care Med., Volume 178, Number 4, August 2008, 363-371 A more recent version of this article appeared on August 15, 2008
Submitted on December 16, 2007 Impact of Burkholderia Infection on Lung Transplantation in Cystic FibrosisSusan Murray1,1 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA; Scientific Registry of Transplant Recipients, Ann Arbor, MI, USA, 2 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA, 3 Cystic Fibrosis Foundation, Bethesda, MD, USA, 4 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA * To whom correspondence should be addressed. E-mail: jlipuma{at}umich.edu.
Rationale: Lung transplantation offers the only survival option for cystic fibrosis (CF) patients with end-stage pulmonary disease. Infection with Burkholderia species is typically considered a contraindication to transplantation in CF. However, the risks posed by different Burkholderia species on transplantation outcomes are poorly defined. Objectives: To quantify the risks of infection with Burkholderia species on survival before and after lung transplantation in CF patients. Methods: Multivariate Cox survival models assessed hazard ratios of infection with Burkholderia species in 1026 lung transplant candidates and 528 lung transplant recipients. Lung allocation scores, incorporating Burkholderia infection status, were calculated for transplant candidates. Measurements and Main Results: Transplant candidates infected with different Burkholderia species did not have statistically different mortality rates. Among transplant recipients infected with B. cenocepacia, only those infected with non-epidemic strains had significantly greater post-transplant mortality compared to uninfected patients (HR=2.52; 95% CI=1.04, 6.12; p=0.04). Hazards were similar between uninfected transplant recipients and those infected with B. multivorans (HR=0.66; 95% CI=0.27, 1.56; p=0.34). Transplant recipients infected with B. gladioli had significantly greater post-transplant mortality than uninfected patients (HR=2.23; 95% C=1.05, 4.74; p=0.04). Once hazards for species/strain were included, lung allocation scores of B. multivorans-infected transplant candidates were comparable to uninfected candidate scores, while those of candidates infected with non-epidemic B. cenocepacia or B. gladioli were lower. Conclusions: Post-transplant mortality among CF patients infected with Burkholderia varies by infecting species. This variability should be taken into account in evaluating lung transplantation candidates. Key words: infection, lung allocation, transplant benefit, Burkholderia
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