Successful Pseudomonas aeruginosa eradication improves outcomes after lung transplantation: a retrospective cohort analysis
- Benedicte De Muynck1,7,
- Anke Van Herck2,7,
- Annelore Sacreas2,
- Tobias Heigl2,
- Janne Kaes2,
- Arno Vanstapel2,
- Stijn E. Verleden2,
- Arne P. Neyrinck3,
- Laurens J. Ceulemans4,
- Dirk E. Van Raemdonck2,4,
- Katrien Lagrou5,6,
- Bart M. Vanaudenaerde2,
- Geert M. Verleden1,2 and
- Robin Vos1,2
- the Leuven Lung Transplant Group
- 1Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
- 2Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- 3Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- 4Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- 5Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- 6Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
- 7Contributed equally
- Prof. Dr. Robin Vos, Dept. of CHROMETA, Lab of BREATHE, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. E-mail: robin.vos{at}uzleuven.be
Abstract
Background Long-term survival after lung transplantation (LTx) is hampered by development of chronic lung allograft dysfunction (CLAD). Pseudomonas aeruginosa (PA) is an established risk factor for CLAD. Therefore, we investigated the effect of PA eradication on CLAD-free and graft survival.
Methods Patients who underwent first LTx between 07/1991–02/2016 and were free from CLAD, were retrospectively classified according to PA presence in respiratory samples between 09/2011 and 09/2016. PA positive patients were subsequently stratified according to success of PA eradication following targeted antibiotic treatment. CLAD-free and graft survival were compared between PA positive and PA negative patients; and between patients with or without successful PA eradication. In addition, pulmonary function was assessed during the first year following PA isolation in both groups.
Results CLAD-free survival of PA negative patients (n=443) was longer compared to PA positive patients (n=95) (p=0.045). Graft survival of PA negative patients (n=443, 82%) was better compared to PA positive patients (n=95, 18%) (p<0.0001). Similarly, PA eradicated patients demonstrated longer CLAD-free survival compared to patients with persistent PA (p=0.018). Pulmonary function was higher in successfully PA eradicated patients compared to unsuccessfully eradicated patients (p=0.035).
Conclusion PA eradication after LTx improves CLAD-free and graft survival and maintains pulmonary function. Therefore, early PA detection and eradication should be pursued.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. De Muynck has nothing to disclose.
Conflict of interest: Dr. Van Herck has nothing to disclose.
Conflict of interest: Dr. Sacreas has nothing to disclose.
Conflict of interest: Dr. Heigl has nothing to disclose.
Conflict of interest: Dr. Kaes has nothing to disclose.
Conflict of interest: Dr. Vanstapel has nothing to disclose.
Conflict of interest: Dr. Verleden reports grants from FWO (12G8715N), grants from KULeuven (C24/18/073), outside the submitted work.
Conflict of interest: Dr. Neyrinck reports grants from KULeuven (C24/18/073), outside the submitted work.
Conflict of interest: Dr. Ceulemans has nothing to disclose.
Conflict of interest: Dr. Van Raemdonck has nothing to disclose.
Conflict of interest: Dr. Lagrou reports personal fees from Pfizer, Abbott, MSD and SMB Laboratoires Brussels, personal fees from Pfizer and MSD, personal fees from Gilead, MSD, Roche, Abbott, outside the submitted work.
Conflict of interest: Dr. Vanaudenaerde reports grants from KULeuven, outside the submitted work.
Conflict of interest: Dr. Verleden reports grants from the Broere Charitable foundation, outside the submitted work.
Conflict of interest: Dr. Vos reports grants from FWO (12G8715N), grants from Roche (trough the Belgian Transplant Society), grants from Sandoz, outside the submitted work.
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- Received May 11, 2020.
- Accepted May 20, 2020.
- Copyright ©ERS 2020