Infections May Increase CF Patients’ Risk of Death in Lung Transplant Surgeries

A recent Dutch study found preoperative infection or inflammation to be associated with worse outcomes in cystic fibrosis (CF) patients undergoing lung transplantation surgery. This finding might help clinicians better estimate risk before such surgery. The study, titled “Pretransplant HRCT Characteristics Are Associated with Worse Outcome of Lung Transplantation for Cystic Fibrosis Patients,“ was published in the journal PLOS ONE.

The study enrolled 53 patients scheduled for lung transplantation surgery at University Medical Centre, in Utrecht, the Netherlands. The team assessed their preoperative status using high-resolution computed tomography (HRCT) in combination with the severe advanced lung disease score (SALD), allowing it to analyze infection/inflammation, air trapping/hypoperfusion, normal/hyperperfusion, and bulla/cysts. Patients also underwent a physical examination, a diabetes screening, and a detailed overview of disease history.

The team found that patients with a dominant preoperative infection or inflammatory disease, according to the SALD score, were more likely to die from postoperative complications. In total, of the patients analyzed, 50% of those with infectious/inflammatory diseases died within one week after the transplant, compared to only 5% of patients with no signs of a dominant infection or inflammation.

Researchers also reported that patients with a dominant preoperative infection or inflammation received more packed red blood cells compared to other patients. In addition, more diabetic patients were found in the group with infection or inflammation, but — likely due to the small size of the study — the team could not prove a statistically significant difference. Scientists also observed that patients with more pleural thickening had more complications during surgery and required more blood transfusion.

The authors of the study, Gerdien Belle-van Meerkerk and colleagues from the Utrecht University Medical Centre, believe that if the results are confirmed in other studies, HRCT can be a useful tool for assessing preoperative and postoperative risk in lung transplant patients with CF. The technique is currently not widely used for perioperative risk estimations.

The team further suggested that the role of diabetes in the development of large airway disease and complications during lung transplantation should be investigated in more detail, as the condition might increase the risk for transplant-related mortality due to higher rates of pulmonary infections.