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Impact of Burkholderia Infection on Lung Transplantation in Cystic Fibrosis
Open accessAbstract
Rationale: Lung transplantation offers the only survival option for patients with cystic fibrosis (CF) with end-stage pulmonary disease. Infection with Burkholderia species is typically considered a contraindication to transplantation in CF. However, the risks posed by different Burkholderia species on transplantation outcomes are poorly defined. Objectives: To quantify the risks of infection with Burkholderia species on survival before and after lung transplantation in patients with CF. Methods: Multivariate Cox survival models assessed hazard ratios of infection with Burkholderia species in 1,026 lung transplant candidates and 528 lung transplant recipients. Lung allocation scores, incorporating Burkholderia infection status, were calculated for transplant candidates. Measurements and Main Results: Transplant candidates infected with different Burkholderia species did not have statistically different mortality rates. Among transplant recipients infected with B. cenocepacia, only those infected with nonepidemic strains had significantly greater post-transplant mortality compared with uninfected patients (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.04–6.12; P = 0.04). Hazards were similar between uninfected transplant recipients and those infected with B. multivorans (HR, 0.66; 95% CI, 0.27–1.56; P = 0.34). Transplant recipients infected with B. gladioli had significantly greater post-transplant mortality than uninfected patients (HR, 2.23; 95% CI, 1.05–4.74; P = 0.04). Once hazards for species/strain were included, lung allocation scores of B. multivorans–infected transplant candidates were comparable to uninfected candidate scores, whereas those of candidates infected with nonepidemic B. cenocepacia or B. gladioli were lower. Conclusions: Post-transplant mortality among patients with CF infected with Burkholderia varies by infecting species. This variability should be taken into account in evaluating lung transplantation candidates.
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“particularly B. cenocepacia has been associated with post-transplant infections and increased mortality especially within the first 6–12 months.(72, 73)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [73]
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Citations
Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793
Regression Models and Life-Tables
Cox, D. R. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_37 · Cited by 26,297
Development of the New Lung Allocation System in the United States
Egan, T. M., Murray, S., Bustami, R. T., Shearon, T. H., McCullough, K. P., Edwards, L. B., Coke, M. A., Garrity, E. R., Sweet, S. C., Heiney, D. A., et al. (2006) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2006.01276.x · Cited by 767
Self-citationMahenthiralingam, E., Bischof, J. M., Byrne, S. K., Radomski, C. C. A., DAVIES, J. E., Av‐Gay, Y., & Vandamme, P. A. R. (2000) · Journal of Clinical Microbiology · doi:10.1128/jcm.38.9.3165-3173.2000 · Cited by 499
Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease
Hosenpud, J. D., Bennett, L. E., Keck, B. M., Edwards, E. B., & Novick, R. J. (1998) · The Lancet · doi:10.1016/s0140-6736(97)06405-2 · Cited by 472
Lung Transplantation for Cystic Fibrosis Patients with Burkholderia cepacia Complex
Aris, R. M., ROUTH, J. C., LiPuma, J. J., Heath, D. G., & Gilligan, P. H. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.164.11.2107022 · Cited by 255
Self-citationBurkholderia cenocepacia and Burkholderia multivorans: influence on survival in cystic fibrosis
Jones, A. M. (2004) · Thorax · doi:10.1136/thx.2003.017210 · Cited by 251
Infection with Burkholderia cepacia in Cystic Fibrosis
Chaparro, C., MAURER, J. R., GUTIERREZ, C., Krajden, M., CHAN, C., Winton, T. L., Keshavjee, S. H., Scavuzzo, M., Tullis, E. D., Hutcheon, M., et al. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.1.9811076 · Cited by 232
Update on the Burkholderia cepacia complex
LiPuma, J. J. (2005) · Current Opinion in Pulmonary Medicine · doi:10.1097/01.mcp.0000181475.85187.ed · Cited by 217
Self-citationLung Transplantation and Survival in Children with Cystic Fibrosis
Liou, T. G., Adler, F. R., Cox, D. R., & Cahill, B. C. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa066359 · Cited by 196
Research works printed but not linked: 6
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- 1997, J R Soc Med, 90, 59
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Sorted by citations
O'Sullivan, B. P., & Freedman, S. D. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60327-5 · Cited by 1,320
Leard, L. E., Holm, A. M., Valapour, M., Glanville, A. R., Attawar, S., Aversa, M., Campos, S. V., Christon, L. M., Cypel, M., Dellgren, G., et al. (2021) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2021.07.005 · Cited by 821
“cenocepacia has been associated with post-transplant infections and increased mortality especially within the first 6-12 months.(72,73) While it may be considered an absolute contraindication at many centers, patients may be candidates at specialized centers that have attained satisfactory outcomes with protocols impl…”
BackgroundClinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis
Hauser, A. R., Jain, M., Bar‐Meir, M., & McColley, S. A. (2011) · Clinical Microbiology Reviews · doi:10.1128/cmr.00036-10 · Cited by 435
Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update
Saiman, L. M., Siegel, J. D., LiPuma, J. J., Brown, R. F., Bryson, E. A., Chambers, M. J., Downer, V. S., Fliege, J. D., Hazle, L., Jain, M., et al. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/676882 · Cited by 405
Self-citationKotloff, R. M., & Thabut, G. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201101-0134ci · Cited by 255
“The observed excessive post-transplant mortality appears largely attributable to Burkholderia cenocepacia (genomovar III) and to a lesser extent, Burkholderia gladioli (18, 19).”
Metadata
- Authors
- Murray, S., Charbeneau, J., Marshall, B. C., & LiPuma, J. J.
- Affiliations
- University of Michigan (US)
- Cystic Fibrosis Foundation (US)
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-08
- Volume
- 178
- Issue
- 4
- Pages
- 363-371
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2081925747
- Semantic Scholar
- 68cf39ee60f9774eb35ae3f703478d0c836ebf29
- Cited by
- 177
- References
- 40
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 13 · 2019: 9 · 2018: 9 · 2017: 12 · 2016: 9 · 2015: 13 · 2014: 14 · 2013: 8 · 2012: 12
- FWCI
- 10.54
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- Cystic Fibrosis Foundation
- Health Resources and Services Administration
- Topics
- Health Sciences › Medicine › Epidemiology › Burkholderia infections and melioidosis
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Microbiology (medical) › Infections and bacterial resistance
- Keywords
- cystic fibrosis, lung transplantation, Burkholderia cenocepacia, Burkholderia multivorans, Burkholderia gladioli, post-transplant mortality, lung allocation score, transplant candidates
- MeSH terms
- Contraindications, Adult, Cystic Fibrosis, Female, Humans, Male, Postoperative Complications, Prognosis, Risk, United States, Cohort Studies, Survival Rate, Multivariate Analysis, Case-Control Studies, Lung Transplantation, Treatment Outcome, Pneumonia, Bacterial, Disease-Free Survival, Burkholderia Infections
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