#ECFS2018 — Hard-to-Treat Infections May Not Impact Survival of CF Patients After Lung Transplant, Study Shows

One-year survival after a lung transplant of cystic fibrosis (CF) patients chronically infected with antibiotic-resistant bacteria is similar to those without infections, according to a retrospective analysis of data from the International Society of Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry.

Results of the study were shared today in a presentation, titled “Mortality outcomes related to multi-drug resistant organisms in cystic fibrosis lung transplant recipients: an International Society of Heart and Lung Transplantation (ISHLT) thoracic transplant Registry study,” at the 2018 European Cystic fibrosis Conference (ECFS), taking place through June 9 in Belgrade, Serbia.

Cystic fibrosis patients often develop pulmonary infections with bacteria that are capable of resisting the action of conventional antibiotics. Although cystic fibrosis is the third most common indication for lung transplants, these multidrug-resistant organisms may affect the long-term success of the procedure in these patients.

Pseudomonas aeruginosa is the predominant bacteria infecting cystic fibrosis patients undergoing a lung transplant evaluation.

Researchers have now compared the one-year mortality rate between CF patients who are negative and those who are positive for chronic infections with multidrug-resistant organisms. They used data from the ISHLT Thoracic Transplant Registry to identify adults with CF who underwent a double lung transplant between 1999 and 2015.

Researchers analyzed data from 3,256 cystic fibrosis who had a lung transplant and found that, even before the surgery, there were significant differences between the two sets of patients. Namely, those who were chronically infected with multidrug-resistant organisms were more likely to be on extra-corporeal life-support and/or ventilation assistance.

These patients were also more likely to have an infection requiring intravenous antibiotic treatment in the two-week period before the transplant, and had a higher rate of pneumonia episodes requiring an infusion of antibiotics in the 12 months preceding the surgery.

Despite this, the one-year mortality post-transplant was similar between CF patients without infections and those chronically infected with multidrug resistant organisms — 16% vs. 18.6%.

First-year deaths that were related to infections, however, were higher in CF patients with multidrug-resistant organisms than in those with no infections — 6.6% vs. 4.6%.

Based on the results, the researchers concluded that the presence of multi-drug resistant organisms was not a predictor of one-year mortality, and suggested that “patients with CF chronically infected with MDRO [multidrug-resistant organisms] should not per se be excluded from LTX [lung transplant] but undergo thorough multi-disciplinary evaluation including infectious diseases specialist input.”