Abstract：
Prior infection with Burkholderia cepacia complex (BCC) has been associated with poorer outcomes after lung transplantation, posing an important dilemma for cystic fibrosis (CF). Although current guidelines consider BCC infection to be a relative contraindication, some centers continue to offer lung transplantation to BCC-infected CF patients.
We conducted a retrospective cohort study which included all consecutive CF-LTR between 2000 and 2019 to compare the postoperative survival of BCC-infected CF lung transplant recipients (CF-LTR) to BCC-uninfected patients. We used a Kaplan-Meier analysis to compare survival of BCC-infected to BCC-uninfected CF-LTR and fitted a multivariable Cox model, adjusted for age, sex, BMI and year of transplantation as potential confounders. As an exploratory analysis, Kaplan-Meier curves were also stratified by the presence of BCC and urgency of transplantation.
A total of 205 patients were included with a mean age of 30.5 years. Seventeen patients (8%) were infected with BCC prior to LT. Patients were infected with the following species: B. multivorans5, B. vietnamiensis3, combined B. multivorans and B. vietnamiensis3 and others4. None of the patients were infected with B. cenocepacia. Three patients were infected with B. gladioli. One-year survival was 91.7% (188/205) for the entire cohort, 82.4% (14/17) among BCC-infected CF-LTR, and 92.5% (173/188) among BCC uninfected CF-LTR (crude HR = 2.19; 95%CI 0.99-4.85; p = 0.05). In the multivariable model, presence of BCC was not significantly associated with worse survival (adjusted HR 1.89; 95%CI 0.85-4.24; p = 0.12). In the stratified analysis for both presence of BCC and urgency of transplantation, urgency of transplantation among BCC-infected CF-LTR appeared to be associated with poorer outcome (p = 0.003 across the 4 subgroups).
Our results suggest that non-cenocepacia BCC-infected CF-LTR have comparable survival rate to BCC-uninfected CF-LTR.
We conducted a retrospective cohort study which included all consecutive CF-LTR between 2000 and 2019 to compare the postoperative survival of BCC-infected CF lung transplant recipients (CF-LTR) to BCC-uninfected patients. We used a Kaplan-Meier analysis to compare survival of BCC-infected to BCC-uninfected CF-LTR and fitted a multivariable Cox model, adjusted for age, sex, BMI and year of transplantation as potential confounders. As an exploratory analysis, Kaplan-Meier curves were also stratified by the presence of BCC and urgency of transplantation.
A total of 205 patients were included with a mean age of 30.5 years. Seventeen patients (8%) were infected with BCC prior to LT. Patients were infected with the following species: B. multivorans5, B. vietnamiensis3, combined B. multivorans and B. vietnamiensis3 and others4. None of the patients were infected with B. cenocepacia. Three patients were infected with B. gladioli. One-year survival was 91.7% (188/205) for the entire cohort, 82.4% (14/17) among BCC-infected CF-LTR, and 92.5% (173/188) among BCC uninfected CF-LTR (crude HR = 2.19; 95%CI 0.99-4.85; p = 0.05). In the multivariable model, presence of BCC was not significantly associated with worse survival (adjusted HR 1.89; 95%CI 0.85-4.24; p = 0.12). In the stratified analysis for both presence of BCC and urgency of transplantation, urgency of transplantation among BCC-infected CF-LTR appeared to be associated with poorer outcome (p = 0.003 across the 4 subgroups).
Our results suggest that non-cenocepacia BCC-infected CF-LTR have comparable survival rate to BCC-uninfected CF-LTR.
摘要：
背景：先前感染洋葱伯克霍尔德氏菌（BCC）与肺移植后较差的预后相关，构成囊性纤维化（CF）的重要困境。尽管目前的指南认为BCC感染是相对禁忌症，一些中心继续为BCC感染的CF患者提供肺移植.
方法：我们进行了一项回顾性队列研究，其中包括2000年至2019年之间的所有连续CF-LTR，以比较BCC感染的CF肺移植受体（CF-LTR）与BCC未感染患者的术后生存率。我们使用Kaplan-Meier分析比较BCC感染与未感染CF-LTR的生存率，并拟合多变量Cox模型，根据年龄调整，性别,BMI和移植年份是潜在的混杂因素。作为探索性分析，Kaplan-Meier曲线也通过BCC的存在和移植的紧迫性而分层。
结果：共纳入205例患者，平均年龄30.5岁。17名患者（8％）在LT之前感染了BCC。患者感染了以下物种：B.multivorans5，B.vietnamienis3，组合B.multivorans和B.vietnamienis3和其他4。所有患者均未感染头孢双歧杆菌。3例患者感染剑兰芽孢杆菌。整个队列的一年生存率为91.7％（188/205），BCC感染的CF-LTR中82.4%(14/17)，BCC未感染CF-LTR的比例为92.5%（173/188）（粗HR=2.19；95CI0.99-4.85；p=0.05）。在多变量模型中，BCC的存在与较差的生存率无显著相关(校正HR1.89;95CI0.85-4.24;p=0.12).在BCC存在和移植紧迫性的分层分析中，BCC感染的CF-LTR中移植的紧迫性似乎与较差的结局相关(4个亚组p=0.003).
结论：我们的研究结果表明，非精隐病BCC感染的CF-LTR与未感染BCC的CF-LTR具有相当的存活率。
方法：我们进行了一项回顾性队列研究，其中包括2000年至2019年之间的所有连续CF-LTR，以比较BCC感染的CF肺移植受体（CF-LTR）与BCC未感染患者的术后生存率。我们使用Kaplan-Meier分析比较BCC感染与未感染CF-LTR的生存率，并拟合多变量Cox模型，根据年龄调整，性别,BMI和移植年份是潜在的混杂因素。作为探索性分析，Kaplan-Meier曲线也通过BCC的存在和移植的紧迫性而分层。
结果：共纳入205例患者，平均年龄30.5岁。17名患者（8％）在LT之前感染了BCC。患者感染了以下物种：B.multivorans5，B.vietnamienis3，组合B.multivorans和B.vietnamienis3和其他4。所有患者均未感染头孢双歧杆菌。3例患者感染剑兰芽孢杆菌。整个队列的一年生存率为91.7％（188/205），BCC感染的CF-LTR中82.4%(14/17)，BCC未感染CF-LTR的比例为92.5%（173/188）（粗HR=2.19；95CI0.99-4.85；p=0.05）。在多变量模型中，BCC的存在与较差的生存率无显著相关(校正HR1.89;95CI0.85-4.24;p=0.12).在BCC存在和移植紧迫性的分层分析中，BCC感染的CF-LTR中移植的紧迫性似乎与较差的结局相关(4个亚组p=0.003).
结论：我们的研究结果表明，非精隐病BCC感染的CF-LTR与未感染BCC的CF-LTR具有相当的存活率。
