Lung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: a single-center experience

J Heart Lung Transplant. 2010 Dec;29(12):1395-404. doi: 10.1016/j.healun.2010.06.007. Epub 2010 Sep 1.


Background: Pre-operative infection with organisms from the Burkholderia cepacia complex (BCC), particularly B cenocepacia, has been linked with a poorer prognosis after transplantation compared to patients with cystic fibrosis (CF) without this infection. Therefore, many transplant centers do not list these patients for transplantation.

Methods: We report the early and long-term results of a cohort of lung transplant recipients with CF and pre-operative BCC infection. Patients with pre-transplantation BCC infection were identified by case-note review. BCC species status was assigned by polymerase chain reaction (PCR)-based techniques. Survival rates were compared to recipients with CF without BCC infection. Survival rates in BCC subgroups were also compared, and then further analyzed pre- and post-2001, when a new immunosuppressive and antibiotic regime was introduced for such patients.

Results: Two hundred sixteen patients with CF underwent lung transplantation and 22 had confirmed pre-operative BCC infection, with 12 of these being B cenocepacia. Nine B cenocepacia-infected recipients died within the first year, and in 8 BCC sepsis was considered to be the cause of death. Despite instituting a tailored peri-operative immunosuppressive and microbiologic care approach for such patients, post-transplantation BCC septic deaths occurred frequently in those with pre-transplantation B cenocepacia infection. In contrast, recipients infected with other BCC species had significantly better outcomes, with post-transplantation survival comparable to other recipients with CF.

Conclusions: Mortality in patients with B cenocepacia infection was unacceptably high and has led to our center no longer accepting patients with this condition onto the lung transplant waiting list. Long-term survival in the non-B cenocepacia BCC group was excellent, without high rates of acute rejection or bronchiolitis obliterans syndrome (BOS) longer term, and these patients continue to be considered for lung transplantation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Burkholderia Infections / drug therapy
  • Burkholderia Infections / microbiology
  • Burkholderia Infections / mortality*
  • Burkholderia cenocepacia / drug effects
  • Burkholderia cenocepacia / isolation & purification
  • Burkholderia cepacia complex / classification*
  • Burkholderia cepacia complex / drug effects
  • Burkholderia cepacia complex / isolation & purification
  • Cause of Death
  • Cohort Studies
  • Cystic Fibrosis / microbiology
  • Cystic Fibrosis / mortality*
  • Cystic Fibrosis / surgery
  • Follow-Up Studies
  • Humans
  • Lung Transplantation / mortality*
  • Retrospective Studies
  • Sepsis / mortality
  • Species Specificity
  • Survival Rate
  • Treatment Outcome


  • Anti-Bacterial Agents