PURPOSE: End stage lung disease resulting in respiratory failure is the major cause of mortality in cystic fibrosis (CF) and leads to lung transplantation. The presence of diabetes mellitus (DM) and a lung allocation score (LAS) >46 portends worse survival. We hypothesize that LAS and DM may increase the risk of infectious and non-infectious complications in CF lung transplant recipients within the first year, thereby impacting mortality.
METHODS: Single center retrospective cohort analysis was performed by reviewing records of all adult CF patients undergoing lung transplantation between 2004 and 2009. Patients received an interleukin-2 receptor antagonist for induction and maintenance immunosuppression with tacrolimus, mycophenolate mofetil and prednisolone. Prophylactic medications included valgangiclovir, TMP-SMX and an azole. We performed bivariate, multivariate and time to event analyses to examine the effect of age, gender, DM, LAS and pre-transplant FEV1 on the risk of acute cellular rejection (ACR), non- CMV and CMV infection.
RESULTS: The sample included 42 transplant recipients, 22 women and 20 men. Median age was 26 years, median FEV1 was 0.81 liters and 67% had DM. ACR occurred in 45%, CMV infection in 19% and bacterial infection in 43%. CMV infection was associated with higher FEV1 (median 1.1 liters versus 0.8 liter), both before (p=0.03) and after (p=0.03) adjustment for other covariates. Time to first rejection was shorter in men, before (p=0.01) and after (p=0.04) adjustment. After excluding 7 patients for whom LAS score was unknown and adjusting for other covariates, patients with higher LAS values were approximately 10% less likely to have bacterial infection (p=0.04).
CONCLUSIONS: ACR, bacterial infection and CMV infection are common in the first year after lung transplant . Higher pre-transplant FEV-1 and lower LAS values, but not diabetes, are associated with CMV infection and bacterial infection, respectively. LAS was not predictive of ACR or CMV infection.
CLINICAL IMPLICATIONS: FEV-1 and LAS play a major role in morbidity post lung transplantation in the CF population. Further investigation in a larger cohort of patients is needed.
DISCLOSURE: The following authors have nothing to disclose: Ngozika Orjioke, Li Yao, Michael Gould, Adupa Rao, Kamyar Afshar, Michael McFadden
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