Infection with Burkholderia cepacia in cystic fibrosis - Outcome followinglung transplantation

As a result of concern over excessive mortality after lung transplantation, many transplant programs refuse to accept cystic fibrosis (CF) patients in fected with Burkholderia cepacia. As a significant proportion of patients w ith CF in our community are infected with this organism, we have continued to provide lung transplantation as an option. A retrospective review was co nducted of medical records of all patients with CF transplanted between Mar ch 1988 and September 1996. Fifty-six transplant procedures were performed in 53 recipients with CF between March 1988 and September 1996. Twenty-eigh t had B, cepacla isolated pretransplant and 25 remaining positive post-tran splant. Of the 53 recipients, 79 have died (15 of 28 [54%] B. cepacia posit ive 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 pos ttransplantation. One-year survival was 67% for B. cepacia positive patient s and 92% for B. cepacia negative patients. Recent modifications in antimic robial and immunosuppressive therapy since 1995 have resulted in no deaths early post-transplant in the last five patients transplanted. We conclude t hat early mortality in patients with CF infected with B, cepacia is signifi cantly higher than in those not infected with B, cepacia. Modifications in post-transplant medical therapy may improve outcome.