Outcomes in cystic fibrosis lung transplant recipients infected with organisms labeled as pan-resistant: An ISHLT Registry‒based analysis

https://doi.org/10.1016/j.healun.2019.01.1306Get rights and content

BACKGROUND

The presence of pan-resistant organisms in patients with cystic fibrosis (CF) potentially impacts mortality after lung transplant (LT). In this study we aimed to study LT mortality in CF patients with and without pan-resistant infection.

METHODS

The International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry was used to identify adults with CF, first-time, bilateral LT from 1991 to 2015. Extracted data included demographics, clinical characteristics, post-transplant outcomes, and mortality (infection-related, overall). Multivariate binary logistic regression models were created with 90-day and 1-year mortality as primary outcomes.

RESULTS

Among 3,256 LT recipients with CF, 697 were labeled as having pan-resistant infection, the others were included as controls (n = 2,649). Pre-transplant, those labeled as pan-resistant were more likely to require ventilator support, have an infection requiring intravenous antibiotics, and have had ≥2 pneumonia episodes within 1 year. Ninety-day and 1-year mortality was similar between groups, but infection-related mortality at 90days (3.3% vs 1.88%, p = 0.01) and 1 year (6.6% vs 4.6%, p < 0.001) was higher in those labeled as pan-resistant. In multivariate analysis, presence of organisms labeled as pan-resistant was not associated with 90-day (odds ratio [OR] 1.5, 95% confidence interval [CI] 0.93 to 2.42, p = 0.09) or 1-year mortality (OR 1.32, 95% CI 0.95 to 1.83, p = 0.097).

CONCLUSIONS

CF patients with pre-transplant infection from organisms labeled as pan-resistant had similar 90-day and 1-year mortality as those without. Despite increased infection-related mortality in these patients, it was not predictive of mortality in multivariate analysis. The higher occurrence of post-transplant infections in these patients warrants diligent follow-up. A multicenter cohort study will be required to validate the findings of our study.

Section snippets

Registry

We conducted a retrospective cohort analysis utilizing the ISHLT Thoracic Transplant Registry, an international longitudinal database collecting data from the pre- and post-transplant periods. Data are collected from 345 international institutions; the ISHLT has data-sharing agreements with 10 data collectives that provide registry data for the majority of the participating institutions, although some institutions individually contribute data as well. A list of institutions can be found in the

Results

The final study population consisted of 3,256 patients with CF. There were 607 patients in the group labeled as having pan-resistant infection, and there were 2,649 control subjects.

Discussion

The prevailing organ scarcity in LT has made it necessary to carefully select patients with ideally a high likelihood of successful outcome.11 Pre-transplant chronic infection or infection with MDR/pan-resistant bacteria has historically been regarded a contraindication for LT at many centers, in some cases even an absolute contraindication.11 However, several small, single-center studies have shown that survival is not generally impaired in those carrying MDR bacteria.14, 15, 19

Through

Disclosure statement

The authors have no conflicts of interest to disclose.

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