ALLOGRAFT COLONIZATION AND INFECTIONS WITH PSEUDOMONAS IN CYSTIC-FIBROSIS LUNG-TRANSPLANT RECIPIENTS

Objective: To assess the incidence of pseudomonal infection, colonizat ion, and inflammation in the allograft of lung transplant recipients w ith cystic fibrosis (CF) as compared with recipients with other end-st age lung disease. Design: Retrospective review. Setting: University me dical center transplant service. Patients: All patients with CF and ch ronic pseudomonal infection (n=62) and patients with nonseptic end-sta ge lung disease (n=52) receiving a double lung transplant between Octo ber 1983 and March 1996. Results: Fifty lung transplant recipients wit h CF survived beyond postoperative day (POD) 15 and were subject to se quential bronchoscopy with BAL. Forty-four CF lung transplant recipien ts had Pseudomonas isolated from the allograft by median POD 15 as com pared with 21 non-CF lung transplant recipients (p<0.001) with isolati on at median POD 158 (p<0.0001). Thirteen CF lung transplant recipient s had histologic evidence of infection when Pseudomonas was isolated a s compared with only three of the non-CF lung transplant recipients (p <0.01). These infections occurred earlier in the CF lung transplant re cipients (median POD 10 vs 261) (p<0.01). When compared with non-CF lu ng transplant recipients, CF lung transplant recipients with Pseudomon as isolated but without concomitant histologic infection (colonized) w ere demonstrated to have increased number of polymorphonuclear cells ( PMNs) in the BAL fluid recovered from the allograft (17.66+/-24.94 x 1 0(6) cells vs 3.46+/-4.73 x 10(6)) (p < 0.05). Non-CF lung transplant recipients who became colonized with Pseudomonas also had a greater nu mber of PMNs recovered when compared with non-CF lung transplant recip ients who did not have Pseudomonas (22.32+/-34.00 x 10(6) cells vs 0.2 1+/-0.18 x 10(6)) (p < 0.01). Nine of 32 (28%) lung transplant recipie nts with CF have died from pseudomonal allograft infections, but this is no greater than 4 of 21 (19%) deaths related to Pseudomonas infecti on in recipients without CF (p=0.34).Conclusions: Isolation of Pseudom onas from the lung allograft occurs more frequently and earlier after transplantation in recipients with CF. While infections related to Pse udomonas also occur more frequently in recipients with CF, there is no increase in mortality. There is an intense inflammatory response in t he lung allograft associated with the isolation of Pseudomonas in reci pients with and without CF.