Successful<i>Pseudomonas aeruginosa</i>eradication improves outcomes after lung transplantation: a retrospective cohort analysis

Abstract

Long-term survival after lung transplantation (LTx) is hampered by development of chronic lung allograft dysfunction (CLAD). <i>Pseudomonas aeruginosa</i> is an established risk factor for CLAD. Therefore, we investigated the effect of <i>P. aeruginosa</i> eradication on CLAD-free and graft survival.Patients who underwent first LTx between July, 1991, and February, 2016, and were free from CLAD, were retrospectively classified according to <i>P. aeruginosa</i> presence in respiratory samples between September, 2011, and September, 2016. <i>P. aeruginosa</i>-positive patients were subsequently stratified according to success of <i>P. aeruginosa</i> eradication following targeted antibiotic treatment. CLAD-free and graft survival were compared between <i>P. aeruginosa</i>-positive and <i>P. aeruginosa</i>-negative patients; and between patients with or without successful <i>P. aeruginosa</i> eradication. In addition, pulmonary function was assessed during the first year following <i>P. aeruginosa</i> isolation in both groups.CLAD-free survival of <i>P. aeruginosa</i>-negative patients (n=443) was longer compared with <i>P. aeruginosa</i>-positive patients (n=95) (p=0.045). Graft survival of <i>P. aeruginosa</i>-negative patients (n=443, 82%) was better compared with <i>P. aeruginosa</i>-positive patients (n=95, 18%) (p<0.0001). Similarly, <i>P. aeruginosa</i>-eradicated patients demonstrated longer CLAD-free and graft survival compared with patients with persistent <i>P. aeruginosa</i> Pulmonary function was higher in successfully <i>P. aeruginosa</i>-eradicated patients compared with unsuccessfully eradicated patients (p=0.035).<i>P. aeruginosa</i> eradication after LTx improves CLAD-free and graft survival and maintains pulmonary function. Therefore, early <i>P. aeruginosa</i> detection and eradication should be pursued.