INFECTIOUS COMPLICATIONS OF LUNG TRANSPLANTATION - IMPACT OF CYSTIC-FIBROSIS

It has been suggested that the presence of airway pathogens prior to l ung transplantation (LT) in patients with cystic fibrosis (CF) may pla ce these patients at a higher risk for infectious complications after LT. There is particular concern regarding patients colonized with mult iresistant Pseudomonas, including P. cepacia, and fungi, including Asp ergillus. We report our experience with LT for patients with CF and co mpare the results with those of patients with LT for other indications . Between January 1990 and March 1993, we performed LT for 27 patients with CF and 32 without CF Nearly all (89%) of the patients with CF we re colonized with P. aeruginosa; many were cultured with P. cepacia (1 9%) and Aspergillus (63%). The non-CF group rarely had organisms ident ified pre-LT. No patients with CF underwent pre-LT sinus drainage or r eceived pre-LT treatment for Aspergillus. All of the patients received perioperative antibiotics and a standard regimen of immunosuppression and prophylactic antibiotics. The incidence of infectious complicatio ns was the same in the two groups; however, there was an association b etween obliterative bronchilitis and pulmonary infections. One of the patients with CF with P. cepacia died as a result of this organism. No ne of the patients with CF required treatment for Asperigillus post-tr ansplant. We conclude that patients with CF, despite the presence of a irway pathogens, are at no greater risk of infectious complications af ter LT than are other patients.