Lung Transplantation for Patients with Cystic Fibrosis and Achromobacter xylosoxidans in the Lung Allocation Score Era

Abstract

Purpose Lung transplantation is an accepted therapy for patients with end stage lung disease due to Cystic Fibrosis (CF). Up to ten percent of patients with CF are colonized with Achromobacter xylosoxidans, a gram negative organism that due to its intrinsic resistance to many antibiotics may affect negatively impact post-transplant outcomes. Methods We conducted a retrospective cohort analysis of all patients receiving lung transplantation for CF from 6/2005-2015 at the University of Pittsburgh Medical Center. Patients with Burkholderia species were excluded. General and transplant related demographics, pre and post-transplant respiratory cultures, and cause of death were examined. Graft survival was measured through February 2018 or last follow-up. Descriptive statistics were used to compare baseline demographics using parametric and non-parametric tests. Survival was estimated and compared by Kaplan Meier analysis. Results Twenty-nine percent (26/89) of patients had a history of Achromobacter infection prior to transplantation. Pre-transplantation, patients with Achromobacter had a slightly higher FEV1 (25.8 +/- 2.1 vs 22.3 +/- 0.07, p=0.031) but trended towards requiring more mechanical ventilation (42 vs 24%, p=0.081). Compared to patients without Achromobacter, there was not a statistically significant difference in 1 year (0.84 vs 0.94%) and 3 year survival (0.68 vs 0.84%) (Figure 1, p=0.291). Of the Achromobacter patients, forty-two percent (11/26) had positive explant bronchial cultures and forty-six percent (12/26) had Achromobacter isolated after transplantation. Of the 12 patients with recurrent Achromobacter, only 4 had positive explant cultures. Only 1 of 11 deaths was attributable to Achromobacter. Conclusion Lung transplantation is a viable treatment option for patients with end stage CF and a history of infection with Achromobacter and these patients should be considered candidates for transplantation.