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A highlight of the session was the concluding debate: BurkholderiaCenocepacia is an Absolute Contradiction to Transplantation between DuaneDavis, MD, Duke University Medical Center, Durham, NC and Redha R. Souilemas,MD, European Georges Pompidou Hospital, Paris.
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Cystic Fibrosis, Burkholderia Cenocepacia and Lung Transplantation
Patients with life threatening lung disease due to CF have a lot to gainby lung transplantation. Compared to other possible indications fortransplant, patients with CF have, in general, the best outcomes, and asuccessful transplant can mean a significant increase in lifespan and a hugeimprovement in quality of life.
A hallmark of advanced CF lung disease is repeated severe chestinfections. In most cases these infections are responsive to treatment withpowerful antibiotics and their presence does not influence the outcomes aftertransplant in CF patients.
However in 5 percent of patients with CF, bacteria called Burkholderiacenocepacia infects the lungs before transplant. This infection is veryresistant to antibiotics and if it returns after the transplant surgery it isextremely difficult to control and can be life threatening.
It is estimated that less than only 30 percent of patients withBurkholderia cenocepacia who receive lung transplants survive beyond fiveyears with many dying very early after transplant due to recurrence of thesevere infection with this bacteria. In comparison, CF patients without thisinfection can expect 5-year post-transplant survival of up to 70 percent onaverage. The debate within the transplant community is whether or not toallocate donor lungs to patients with Burkholderia cenocepacia knowing thatthe success rate is much worse than in CF patients without this infection.
According to Dr. Davis, lung transplants should not be performed on CFpatients with Burkholderia cenocepacia until new research indicates a way toachieve better early results by better control of the infection. He went onto say new ways of treating patients with Burkholderia cenocepacia should beexamined in clinical trials with a hypothesis, careful data collection andsafety monitoring. Only after such research approaches havegenerated a clinical advance in treatment of this infection should lungtransplants in CF patients with Burkholderia cenocepacia be performed in thesame manner as those who do not have the disease.
Representing the counter argument, Dr. Souilemas said he believes it isvery difficult to choose between two patients who need the same procedure."Medicine is science and art," said Dr. Souilemas in the debate. During hisargument, Dr. Souilemas also presented information on reversible factors otherthan the infection itself, which may contribute to the patients' poor healthbefore receiving a lung transplant, and thus contribute to poor outcomes. Dr.Souilemas finished his debate by proposing that each patient be viewed as apotential lung transplant candidate and encouraged clinicians to attempt totransplant each as successfully as possible.
In the end, both physicians agreed that more careful research intotransplants in CF patients with Burkholderia cenocepacia would improve successrates for these patients.
About ISHLT
The International Society for Heart and Lung Transplantation (ISHLT) is anot-for-profit organization dedicated to the advancement of the science andtreatment of end-stage heart and lung diseases. Created in 1981, the societynow includes more than 3,000 members from more th
