Allograft Colonization andInfections WithPseudomonas inCystic Fibrosis LungTransplant Recipients

Objective: To assesstheincidence ofpseudomonal infection, colonization, andinflammation in theallograft oflung transplant recipients withcystic fibrosis (CF) ascompared withrecipients withotherend-stage lung disease. Design: Retrospective review. Setting: University medical centertransplant service. Patients: Allpatients withCF andchronic pseudomonal infection (n=62) andpatients with nonseptic end-stage lung disease (n=52) receiving a doublelung transplant between October 1983andMarch1996. Results: Fifty lung transplant recipients withCFsurvived beyond postoperative day (POD) 15and were subject tosequential bronchoscopy withBAL.Forty-four CFlung transplant recipients had Pseudomonas isolated fromtheallograft bymedian POD 15ascompared with21non-CFlung transplant recipients (p< 0.001) withisolation atmedian POD 158(p<0.0001). Thirteen CFlung transplant recipients hadhistologic evidence ofinfection whenPseudomonas was isolated as compared withonly three ofthenon-CFlung transplant recipients (p<0.01). Theseinfections occurred earlier intheCFlung transplant recipients (median POD 10vs261)(p<0.01). When compared withnon-CFlung transplant recipients, CFlung transplant recipients withPseudo¬ monas isolated butwithout concomitant histologic infection (colonized) were demonstrated to haveincreased numberofpolymorphonuclear cells (PMNs) intheBALfluid recovered fromthe allograft (17.66±24.94x 106cells vs3.46+4.73X106) (p<0.05). Non-CFlung transplant recipients whobecamecolonized withPseudomonas also hada greater numberofPMNsrecovered when compared withnon-CFlungtransplant recipients who didnot havePseudomonas (22.32±34.00x 106cells vs0.21+0.18X106) (p<0.01). Nineof32(28%) lung transplant recipients with CFhavediedfrompseudomonal allograft infections, butthis isno greater than4of21(19%) deaths related toPseudomonas infection inrecipients without CF(p=0.34). Conclusions: Isolation ofPseudomonas fromthelung allograft occurs more frequently andearlier after transplantation inrecipients withCF.Whileinfections related toPseudomonas also occur more frequently inrecipients withCF,there isno increase inmortality. Thereisan intense inflammatory response inthelung allograft associated withtheisolation ofPseudomonas in recipients withandwithout CF. (CHEST 1998; 113:1235-43)