Risk of bronchial dehiscence in lung transplant recipients with carbapenemase producing Klebsiella

Abstract Background Klebsiella pneumonia is commonly isolated after lung transplantation. We observed an increase in bronchial complications following an outbreak of Klebsiella pneumoniae carbapenemase-producing Klebsiella (KPC-KP). Methods The study enrolled 173 patients, who had undergone bilateral lung transplantation between 2012 and 2018, to examine the association between bronchial complications following lung transplantation, and KPC-KP. The KPC-KP group was defined as patients in whom isolates from sputum or bronchoalveolar lavage (BAL) fluid were positive for KPC-KP. The presence of bronchial complications was defined as a positive finding on bronchoscopy in accordance with the criteria of the International Society for Heart and Lung Transplantation. Risk factors for bronchial complications were analyzed. Results KPC-KP was identified in 29 patients (16.8%), and bronchial dehiscence was observed in 13 patients (7.5%). Smoking [odds ratio (OR) 5.690, 95% confidence interval (CI) 1.106-29.260, P=0.037], presence of KPC-KP (OR 5.360, 95% CI 1.380-20.810, P=0.015), and bronchial necrosis (OR 7.009, 95% CI 1.811-27.124, P=0.005) were associated with bronchial dehiscence in a multivariate logistic regression model. Conclusions The presence of KPC-KP in lung-transplant recipients significantly increased the risk of bronchial dehiscence, independent of bronchial necrosis. Thus, patients with KPC-KP require greater surveillance and follow-up bronchoscopy, irrespective of the presence or absence of bronchial necrosis or the overall patient condition.