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.
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。