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Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?

¹ Laboratory of Pneumology, ² Laboratory of Experimental Thoracic Surgery, Katholieke Universiteit Leuven, ³ Lung Transplantation Unit, Depts of ⁴ Respiratory Disease, and ⁵ Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium.

CORRESPONDENCE: G. M. Verleden, University Hospital Gasthuisberg, Lung Transplantation Unit, 49 Herestraat, B3000 Leuven, Belgium. Fax: 32 16346803. E-mail: geert.verleden{at}uz.kuleuven.ac.be

Keywords: Airway colonisation, bronchiolitis obliterans syndrome, lung transplantation, Pseudomonas aeruginosa

Received: October 1, 2007
Accepted January 18, 2008

Airway colonisation with Pseudomonads, especially Pseudomonas aeruginosa, is common in lung transplant (LTx) recipients. The current authors investigated whether pseudomonal colonisation affects the prevalence of bronchiolitis obliterans syndrome (BOS) after lung transplantation.

In the present retrospective study, 92 double (SS)LTx recipients (26 cystic fibrosis (CF) and 66 non-CF patients), with at least two consecutive post-operative bronchoalveolar lavage or sputum cultures evaluated for Pseudomonads, were included. Freedom of BOS was investigated in post-operatively colonised and noncolonised patients.

The current study has shown post-operative airway colonisation to be an independent risk factor for BOS stage 1 and to be associated with a worse BOS stage 1-free survival in univariate analysis, especially in CF SSLTx recipients. Multivariate analysis demonstrated a trend for colonisation only as an independent risk factor for BOS; however, this pointed to a possible role in the development of BOS.

In conclusion, pseudomonal airway colonisation after lung transplantation may be associated with an increased prevalence of bronchiolitis obliterans syndrome, especially in cystic fibrosis patients. Possible pathophysiological mechanisms in the development of bronchiolitis obliterans syndrome need further investigation, although the induction of neutrophilic airway inflammation seems to be its main characteristic.