Outcome and prognostic factors after lung transplantation for bronchiectasis other than cystic fibrosis

Abstract

Background While lung transplant (LTX) can be an effective therapy to provide the survival benefit in selected populations, post-transplant outcome in LTX recipients with bronchiectasis other than cystic fibrosis (CF) has been less studied. Pseudomonas aeruginosa, often associated with exacerbations in bronchiectasis, is the most common micro-organism isolated from LTX recipients. We aimed to see the outcomes of patients with bronchiectasis other than CF after LTX and seek the risk factors associated with pre- and post-transplant Pseudomonas status. Methods Patients who underwent LTX at Tohoku University Hospital between January 2000 and December 2020 were consecutively included into the retrospective cohort study. Pre- and post-transplant prevalence of Pseudomonas colonization between bronchiectasis and other diseases was reviewed. Post-transplant outcomes (mortality and the development of chronic lung allograft dysfunction (CLAD)) were assessed using a Cox proportional hazards and time-to-event outcomes were estimated using the Kaplan–Meier method. Results LTX recipients with bronchiectasis experienced a high rate of pre- and post-transplant Pseudomonas colonization compared to other diseases with statistical significance (p < 0.001 and p < 0.001, respectively). Nevertheless, long-term survival in bronchiectasis was as great as non-bronchiectasis (Log-rank p = 0.522), and the bronchiectasis was not a trigger for death (HR 1.62, 95% CI 0.63–4.19). On the other hand, the chance of CLAD onset in bronchiectasis was comparable to non-bronchiectasis (Log-rank p = 0.221), and bronchiectasis was not a predictor of the development of CLAD (HR 1.88, 95% CI 0.65–5.40). Conclusions Despite high prevalence of pre- and post-transplant Pseudomonas colonization, the outcome in LTX recipients with bronchiectasis other than CF was comparable to those without bronchiectasis.

Waiting time and mortality rate on lung transplant candidates in Japan: a single-center retrospective cohort study

“…4 ). Further, bronchiectasis was categorized into the Suppurative, rather than the Obstructive, category since cystic fibrosis is extremely rare in Japan [ 18 , 19 ]. Compared with other countries, Japan has more cases of pulmonary complications after hematopoietic stem cell transplantation listed for LTX [ 7 , 20 ].…”

Native-lung complications following single-lung transplantation for interstitial lung disease: an in-depth analysis

“…Pulmonary aspergillosis in the native lung was identified in four out of 34 (11.8%) ILD SLTx recipients, with a median time to diagnosis of 6.0 months (IQR: 4.8–19.8). Notably, these ILD SLTx recipients developed pulmonary aspergillosis despite receiving antifungal prophylaxis with itraconazole or voriconazole [ 9 ]. With the administration of high dosages of voriconazole, no progression of pulmonary aspergillosis was observed.…”

“…The analysis excluded recipients who had undergone BLTx ( n = 61). It is worth noting that prior studies have documented the transplant registry in Japan [ 8 ], intraoperative management, and chronic phase care [ 9 , 10 ], immunosuppressive therapy [ 11 ], histocompatibility testing after LTx [ 12 ], and antimicrobial prophylaxis [ 9 , 13 ]. The diagnosis of acute exacerbation of ILD in the native lung following SLTx was established on the basis of the emergence of new ground-glass opacities exclusively within the native lung post-discharge from the intensive care unit (ICU), explicitly excluding cases associated with heart failure [ 14 ].…”

Efficacy and safety of mRNA SARS-CoV-2 vaccines in lung transplant recipients

“…The study group included LTX recipients who were 6 months out from transplantation and followed at TUH. LTX indications [ 4 ], immunosuppression [ 5 ], histocompatibility testing [ 6 ], antimicrobial prophylaxis [ 7 ] and overall management [ 8 ] after transplantation have been previously described. Plasma mycophenolate concentration was measured based on the 12-h area under the concentration-time curve (AUC0-12) by a three time-point (C1, C4, and C8) sampling strategy [ 9 ].…”