Successful Pseudomonas aeruginosa eradication improves outcomes after lung transplantation: a retrospective cohort analysis.

Long-term survival after lung transplantation (LTx) is hampered by development of chronic lung allograft dysfunction (CLAD). Pseudomonas aeruginosa is an established risk factor for CLAD. Therefore, we investigated the effect of P. aeruginosa 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 P. aeruginosa presence in respiratory samples between September, 2011, and September, 2016. P. aeruginosa -positive patients were subsequently stratified according to success of P. aeruginosa eradication following targeted antibiotic treatment. CLAD-free and graft survival were compared between P. aeruginosa -positive and P. aeruginosa -negative patients; and between patients with or without successful P. aeruginosa eradication. In addition, pulmonary function was assessed during the first year following P. aeruginosa isolation in both groups.CLAD-free survival of P. aeruginosa -negative patients (n=443) was longer compared with P. aeruginosa -positive patients (n=95) (p=0.045). Graft survival of P. aeruginosa -negative patients (n=443, 82%) was better compared with P. aeruginosa -positive patients (n=95, 18%) (p<0.0001). Similarly, P. aeruginosa -eradicated patients demonstrated longer CLAD-free and graft survival compared with patients with persistent P. aeruginosa Pulmonary function was higher in successfully P. aeruginosa -eradicated patients compared with unsuccessfully eradicated patients (p=0.035). P. aeruginosa eradication after LTx improves CLAD-free and graft survival and maintains pulmonary function. Therefore, early P. aeruginosa detection and eradication should be pursued.
Competing Interests: Conflict of interest: B. De Muynck has nothing to disclose. Conflict of interest: A. Van Herck has nothing to disclose. Conflict of interest: A. Sacreas has nothing to disclose. Conflict of interest: T. Heigl has nothing to disclose. Conflict of interest: J. Kaes has nothing to disclose. Conflict of interest: A. Vanstapel has nothing to disclose. Conflict of interest: S.E. Verleden reports grants from FWO (12G8715N) and KULeuven (C24/18/073), outside the submitted work. Conflict of interest: A.P. Neyrinck reports grants from KULeuven (C24/18/073), outside the submitted work. Conflict of interest: L.J. Ceulemans has nothing to disclose. Conflict of interest: D.E. Van Raemdonck has nothing to disclose. Conflict of interest: K. Lagrou reports personal fees for consultancy from Pfizer, Abbott, MSD and SMB Laboratoires Brussels, personal fees for travel support from Pfizer and MSD, personal fees for lectures from Gilead, MSD, Roche and Abbott, outside the submitted work. Conflict of interest: B.M. Vanaudenaerde reports grants from KULeuven, outside the submitted work. Conflict of interest: G.M. Verleden reports grants from the Broere Charitable foundation, outside the submitted work. Conflict of interest: R. Vos reports grants from FWO (12G8715N), Roche (through the Belgian Transplant Society and Sandoz, outside the submitted work.
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