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Impact of graft colonization with gram-negative bacteria after lung transplantation on the development of bronchiolitis obliterans syndrome in recipients with cystic fibrosis.
MedLine Citation:
PMID:  19117741     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Bronchiolitis obliterans syndrome (BOS) represents the leading cause of late mortality after lung transplantation (LTx). Cystic fibrosis (CF) patients frequently show airway colonization with gram-negative bacteria (GNB) both before and after LTx. Graft colonization with GNB and its relevance towards BOS development were investigated in a CF population after LTx. Adult CF patients receiving LTx and surviving at least 6 months were included in this prospective observational study between 1/1/2002 and 30/6/2006 in a single center and followed until 31/3/2007. Pre- and post-LTx respiratory culture samples were compared for the presence of identical GNB. BOS-free survival was compared in colonized and non-colonized patients. Fifty-nine adult CF patients with a median age at LTx of 25.5 (18-49) years were included and had a median follow-up of 966 (128-1889) days. Seven patients (15%) demonstrated immediate eradication of GNB in lower respiratory tract samples. A further 18 patients (34%) demonstrated transient colonization. Thirty-four recipients had further positive samples after LTx. Eighteen patients (31%) developed BOS >or=stage 1, 508 (114-1167) days after LTx. Freedom of graft colonization with pseudomonads was independently associated with less frequent development of BOS (p=0.006). Persistent graft colonization with pseudomonads increases the prevalence of BOS after LTx in CF patients. A significant proportion of post-LTx CF patients demonstrates subsequent GNB eradication during later follow-up and this may have a protective role against development of BOS. Strategies to eradicate airway colonization or reduce bacterial load may prevent BOS in CF patients after LTx.
Authors:
J Gottlieb; F Mattner; H Weissbrodt; M Dierich; T Fuehner; M Strueber; A Simon; T Welte
Publication Detail:
Type:  Journal Article     Date:  2008-12-30
Journal Detail:
Title:  Respiratory medicine     Volume:  103     ISSN:  1532-3064     ISO Abbreviation:  Respir Med     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-03-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  743-9     Citation Subset:  IM    
Affiliation:
Department of Respiratory Medicine OE6870, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. gottlieb.jens@mh-hannover.de
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