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Background <p>Lung transplantation is the ultimate treatment option for patients with advanced cystic fibrosis. Chronic colonization of these recipients with multidrug-resistant (MDR) pathogens may constitute a risk factor for an adverse outcome. We sought to analyze whether colonization with MDR pathogens, as outlined in the German classification of multiresistant Gram-negative bacteria (MRGN), was associated with the success of lung transplantation.</p> Methods <p>We performed a monocentric retrospective analysis of 361 lung transplantations performed in Homburg, Germany, between 1995 and 2020. All recipients with a main diagnosis of cystic fibrosis (<i>n</i> = 69) were stratified into two groups based on colonization with <i>Pseudomonas aeruginosa</i> in view of MRGN before transplantation: no colonization and colonization without (<i>n</i> = 23) <i>or</i> with (<i>n</i> = 46) resistance to three or four antibiotic groups (3MRGN/4MRGN). Multivariable analyses were performed including various clinical parameters (preoperative data, postoperative data).</p> Results <p>CF patients colonized with multidrug-resistant pathogens (<i>Pseudomonas aeruginosa</i>) classified as 3MRGN/4MRGN had poorer survival (median survival 16 years (without MRGN) <i>versus</i> 8 years (with MRGN), <i>P</i> = 0.048). Extracorporeal support (<i>P</i> = 0.014, HR = 2.929), re-transplantation (<i>P</i> = 0.023, HR = 2.303), female sex (<i>P</i> = 0.019, HR = 2.244) and 3MRGN/4MRGN (<i>P</i> = 0.036, HR = 2.376) were predictors of poor outcomes in the multivariate analysis. Co-colonization with the mold <i>Aspergillus fumigatus</i> was further associated with mortality risk in the 3MRGN/4MRGN group (<i>P</i> = 0.037, HR = 2.150).</p> Conclusion <p>Patients with cystic fibrosis and MDR colonization (<i>Pseudomonas aeruginosa</i>) are risk candidates for lung transplantation, targeted diagnostics and tailored anti-infective strategies are essential for survival after surgery. MDR colonization as expressed by MRGN may help to identify patients at increased risk to improve the organ allocation process.</p>

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Risk factors for survival after lung transplantation in cystic fibrosis: impact of colonization with multidrug-resistant strains of Pseudomonas aeruginosa

  • 期刊论文

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  • 发表日期：

    2025年1月30日

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  • Bettina Weingard,
  • Sören L. Becker,
  • Sophie Schneitler,
  • Franziska C. Trudzinski,
  • Robert Bals,
  • Heinrike Wilkens,
  • Frank Langer

摘要

Background

Lung transplantation is the ultimate treatment option for patients with advanced cystic fibrosis. Chronic colonization of these recipients with multidrug-resistant (MDR) pathogens may constitute a risk factor for an adverse outcome. We sought to analyze whether colonization with MDR pathogens, as outlined in the German classification of multiresistant Gram-negative bacteria (MRGN), was associated with the success of lung transplantation.

Methods

We performed a monocentric retrospective analysis of 361 lung transplantations performed in Homburg, Germany, between 1995 and 2020. All recipients with a main diagnosis of cystic fibrosis (n = 69) were stratified into two groups based on colonization with Pseudomonas aeruginosa in view of MRGN before transplantation: no colonization and colonization without (n = 23) or with (n = 46) resistance to three or four antibiotic groups (3MRGN/4MRGN). Multivariable analyses were performed including various clinical parameters (preoperative data, postoperative data).

Results

CF patients colonized with multidrug-resistant pathogens (Pseudomonas aeruginosa) classified as 3MRGN/4MRGN had poorer survival (median survival 16 years (without MRGN) versus 8 years (with MRGN), P = 0.048). Extracorporeal support (P = 0.014, HR = 2.929), re-transplantation (P = 0.023, HR = 2.303), female sex (P = 0.019, HR = 2.244) and 3MRGN/4MRGN (P = 0.036, HR = 2.376) were predictors of poor outcomes in the multivariate analysis. Co-colonization with the mold Aspergillus fumigatus was further associated with mortality risk in the 3MRGN/4MRGN group (P = 0.037, HR = 2.150).

Conclusion

Patients with cystic fibrosis and MDR colonization (Pseudomonas aeruginosa) are risk candidates for lung transplantation, targeted diagnostics and tailored anti-infective strategies are essential for survival after surgery. MDR colonization as expressed by MRGN may help to identify patients at increased risk to improve the organ allocation process.