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DOI: 10.1055/s-0030-1249109
Lung Transplantation for Advanced Bronchiectasis
Publication History
Publication Date:
30 March 2010 (online)
ABSTRACT
Lung transplant (LT) can be successfully performed on patients with advanced bronchiectatic lung disease with subsequent good posttransplant quality of life and long-term outcome. Most of the data are derived from patients with cystic fibrosis (CF), but LT can be effective in patients with non-CF bronchiectasis as well. Despite the presence of chronic lower respiratory tract infection with bacterial pathogens in these patients pretransplant, posttransplant infections do not generally have significant impact on survival, although infection with antibiotic-resistant bacteria may complicate posttransplant management. Although benefit of LT for young children with CF is somewhat controversial, LT can clearly benefit older children and adults with advanced lung disease due to bronchiectasis. This article reviews indications (and contraindications) for LT, discusses particular problems that may arise posttransplant, and provides a rationale for referring patients with bronchiectasis for LT.
KEYWORDS
Cystic fibrosis - bronchiectasis - lung transplantation
REFERENCES
- 1 Barker A F. Bronchiectasis. N Engl J Med. 2002; 346 1383-1393
- 2 O'Donnell A E. Bronchiectasis. Chest. 2008; 134 815-823
- 3 Loebinger M R, Wells A U, Hansell D M et al.. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009; 34 843-849
- 4 Courtney J M, Kelly M G, Watt A et al.. Quality of life and inflammation in exacerbations of bronchiectasis. Chron Respir Dis. 2008; 5 161-168
- 5 Feltrim M I, Rozanski A, Borges A C, Cardoso C A, Caramori M L, Pego-Fernandes P. The quality of life of patients on the lung transplantation waiting list. Transplant Proc. 2008; 40 819-821
- 6 Kerem B, Rommens J M, Buchanan J A et al.. Identification of the cystic fibrosis gene: genetic analysis. Science. 1989; 245 1073-1080
- 7 Mueller C, Flotte T R. Gene therapy for cystic fibrosis. Clin Rev Allergy Immunol. 2008; 35 164-178
- 8 Ratjen F, Döring G. Cystic fibrosis. Lancet. 2003; 361 681-689
- 9 Tunney M M, Field T R, Moriarty T F et al.. Detection of anaerobic bacteria in high numbers in sputum from patients with cystic fibrosis. Am J Respir Crit Care Med. 2008; 177 995-1001
- 10 Worlitzsch D, Tarran R, Ulrich M et al.. Reduced oxygen concentrations in airway mucus contribute to the early and late pathogenesis of Pseudomonas aeruginosa cystic fibrosis airways infection. J Clin Invest. 2002; 109 317-325
- 11 Høiby N, Frederiksen B, Pressler T. Eradication of early Pseudomonas aeruginosa infection. J Cyst Fibros. 2005; 4(Suppl 2) 49-54
- 12 Christie J D, Edwards L B, Aurora P et al.. The registry of the International Society for Heart and Lung Transplantation: Twenty-Sixth Official Adult Lung and Heart–Lung Transplantation Report–2009. J Heart Lung Transplant. 2009; 28 1031-1049
- 13 Orens J B, Estenne M, Arcasoy S Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2006; 25 745-755
- 14 Bartz R R, Love R B, Leverson G E, Will L R, Welter D L, Meyer K C. Pre-transplant mechanical ventilation and outcome in patients with cystic fibrosis. J Heart Lung Transplant. 2003; 22 433-438
- 15 Kerem E, Reisman J, Corey M, Canny G J, Levison H. Prediction of mortality in patients with cystic fibrosis. N Engl J Med. 1992; 326 1187-1191
- 16 Maurer J R, Frost A E, Estenne M, Higenbottam T, Glanville A R. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society. J Heart Lung Transplant. 1998; 17 703-709
- 17 Mayer-Hamblett N, Rosenfeld M, Emerson J, Goss C H, Aitken M L. Developing cystic fibrosis lung transplant referral criteria using predictors of 2-year mortality. Am J Respir Crit Care Med. 2002; 166(12 Pt 1) 1550-1555
- 18 Rosenbluth D B, Wilson K, Ferkol T, Schuster D P. Lung function decline in cystic fibrosis patients and timing for lung transplantation referral. Chest. 2004; 126 412-419
- 19 Ellaffi M, Vinsonneau C, Coste J et al.. One-year outcome after severe pulmonary exacerbation in adults with cystic fibrosis. Am J Respir Crit Care Med. 2005; 171 158-164
- 20 Milla C E, Warwick W J. Risk of death in cystic fibrosis patients with severely compromised lung function. Chest. 1998; 113 1230-1234
- 21 Doershuk C F, Stern R C. Timing of referral for lung transplantation for cystic fibrosis: overemphasis on FEV1 may adversely affect overall survival. Chest. 1999; 115 782-787
- 22 Augarten A, Akons H, Aviram M et al.. Prediction of mortality and timing of referral for lung transplantation in cystic fibrosis patients. Pediatr Transplant. 2001; 5 339-342
- 23 Belkin R A, Henig N R, Singer L G et al.. Risk factors for death of patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med. 2006; 173 659-666
- 24 Snell G I, Bennetts K, Bartolo J et al.. Body mass index as a predictor of survival in adults with cystic fibrosis referred for lung transplantation. J Heart Lung Transplant. 1998; 17 1097-1103
- 25 Stanchina M L, Tantisira K G, Aquino S L, Wain J C, Ginns L C. Association of lung perfusion disparity and mortality in patients with cystic fibrosis awaiting lung transplantation. J Heart Lung Transplant. 2002; 21 217-225
- 26 Tantisira K G, Systrom D M, Ginns L C. An elevated breathing reserve index at the lactate threshold is a predictor of mortality in patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med. 2002; 165 1629-1633
- 27 Liou T G, Adler F R, Cahill B C et al.. Survival effect of lung transplantation among patients with cystic fibrosis. JAMA. 2001; 286 2683-2689
- 28 Liou T G, Adler F R, Huang D. Use of lung transplantation survival models to refine patient selection in cystic fibrosis. Am J Respir Crit Care Med. 2005; 171 1053-1059
- 29 Liou T G, Adler F R, Cox D R, Cahill B C. Lung transplantation and survival in children with cystic fibrosis. N Engl J Med. 2007; 357 2143-2152
- 30 Egan T M. Solid benefit of lung transplantation for some children with cystic fibrosis. Pediatr Transplant. 2008; 12 125-128
- 31 Sweet S C, Aurora P, Benden C International Pediatric Lung Transplant Collaborative et al. Lung transplantation and survival in children with cystic fibrosis: solid statistics—flawed interpretation. Pediatr Transplant. 2008; 12 129-136
- 32 Aurora P, Carby M, Sweet S. Selection of cystic fibrosis patients for lung transplantation. Curr Opin Pulm Med. 2008; 14 589-594
- 33 Ziedalski T M, Kao P N, Henig N R, Jacobs S S, Ruoss S J. Prospective analysis of cystic fibrosis transmembrane regulator mutations in adults with bronchiectasis or pulmonary nontuberculous mycobacterial infection. Chest. 2006; 130 995-1002
- 34 Hasan A, Corris P A, Healy M et al.. Bilateral sequential lung transplantation for end stage septic lung disease. Thorax. 1995; 50 565-566
- 35 Arcasoy S M, Kotloff R M. Lung transplantation. N Engl J Med. 1999; 340 1081-1091
- 36 Barlow C W, Robbins R C, Moon M R, Akindipe O, Theodore J, Reitz B A. Heart-lung versus double-lung transplantation for suppurative lung disease. J Thorac Cardiovasc Surg. 2000; 119 466-476
- 37 Rao J N, Forty J, Hasan A et al.. Bilateral lung transplant: the procedure of choice for end-stage septic lung disease. Transplant Proc. 2001; 33 1622-1623
- 38 Beirne P A, Banner N R, Khaghani A, Hodson M E, Yacoub M H. Lung transplantation for non-cystic fibrosis bronchiectasis: analysis of a 13-year experience. J Heart Lung Transplant. 2005; 24 1530-1535
- 39 Ikegami T, Sanchez E Q, Uemura T et al.. Liver transplantation for cystic fibrosis in adults. Surg Today. 2008; 38 26-29
- 40 Fridell J A, Bond G J, Mazariegos G V et al.. Liver transplantation in children with cystic fibrosis: a long-term longitudinal review of a single center's experience. J Pediatr Surg. 2003; 38 1152-1156
- 41 Milkiewicz P, Skiba G, Kelly D et al.. Transplantation for cystic fibrosis: outcome following early liver transplantation. J Gastroenterol Hepatol. 2002; 17 208-213
- 42 Forty J, Hasan A, Gould F K, Corris P A, Dark J H. Single lung transplantation with simultaneous contralateral pneumonectomy for cystic fibrosis. J Heart Lung Transplant. 1994; 13 727-730
- 43 Souilamas R, Mostafa A, Guillemain R, Boussaud V, Amrein C, Chevalier P. Single-lung transplantation for cystic fibrosis and metachronus pneumonectomy: case reports. Transplant Proc. 2008; 40 3594-3595
- 44 Wilson C B, Jones P W, O'Leary C J, Hansell D M, Cole P J, Wilson R. Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Eur Respir J. 1997; 10 1754-1760
- 45 Martínez-García M A, Soler-Cataluña J J, Perpiñá-Tordera M, Román-Sánchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007; 132 1565-1572
- 46 Aris R M, Gilligan P H, Neuringer I P, Gott K K, Rea J, Yankaskas J R. The effects of panresistant bacteria in cystic fibrosis patients on lung transplant outcome. Am J Respir Crit Care Med. 1997; 155 1699-1704
- 47 Hadjiliadis D, Steele M P, Chaparro C et al.. Survival of lung transplant patients with cystic fibrosis harboring panresistant bacteria other than Burkholderia cepacia, compared with patients harboring sensitive bacteria. J Heart Lung Transplant. 2007; 26 834-838
- 48 De Soyza A, Archer L, Wardle J et al.. Pulmonary transplantation for cystic fibrosis: pre-transplant recipient characteristics in patients dying of peri-operative sepsis. J Heart Lung Transplant. 2003; 22 764-769
- 49 Dobbin C, Maley M, Harkness J et al.. The impact of pan-resistant bacterial pathogens on survival after lung transplantation in cystic fibrosis: results from a single large referral centre. J Hosp Infect. 2004; 56 277-282
- 50 Helmi M, Love R B, Welter D, Cornwell R D, Meyer K C. Aspergillus infection in lung transplant recipients with cystic fibrosis: risk factors and outcomes comparison to other types of transplant recipients. Chest. 2003; 123 800-808
- 51 Nunley D R, Ohori P, Grgurich W F et al.. Pulmonary aspergillosis in cystic fibrosis lung transplant recipients. Chest. 1998; 114 1321-1329
- 52 Cimon B, Carrère J, Vinatier J F, Chazalette J P, Chabasse D, Bouchara J P. Clinical significance of Scedosporium apiospermum in patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis. 2000; 19 53-56
- 53 Symoens F, Knoop C, Schrooyen M et al.. Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation. J Heart Lung Transplant. 2006; 25 603-607
- 54 Chernenko S M, Humar A, Hutcheon M et al.. Mycobacterium abscessus infections in lung transplant recipients: the international experience. J Heart Lung Transplant. 2006; 25 1447-1455
- 55 Chalermskulrat W, Sood N, Neuringer I P et al.. Non-tuberculous mycobacteria in end stage cystic fibrosis: implications for lung transplantation. Thorax. 2006; 61 507-513
- 56 Aris R M, Routh J C, LiPuma J J, Heath D G, Gilligan P H. Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex. Survival linked to genomovar type. Am J Respir Crit Care Med. 2001; 164 2102-2106
- 57 Liou T G, Adler F R, Huang D. Use of lung transplantation survival models to refine patient selection in cystic fibrosis. Am J Respir Crit Care Med. 2005; 171 1053-1059
- 58 Alexander B D, Petzold E W, Reller L B et al.. Survival after lung transplantation of cystic fibrosis patients infected with Burkholderia cepacia complex. Am J Transplant. 2008; 8 1025-1030
- 59 Murray S, Charbeneau J, Marshall B C, LiPuma J J. Impact of Burkholderia infection on lung transplantation in cystic fibrosis. Am J Respir Crit Care Med. 2008; 178 363-371
- 60 Snell G I, Levvey B J, Oto T et al.. Early lung transplantation success utilizing controlled donation after cardiac death donors. Am J Transplant. 2008; 8 1282-1289
- 61 Cypel M, Sato M, Yildirim E et al.. Initial experience with lung donation after cardiocirculatory death in Canada. J Heart Lung Transplant. 2009; 28 753-758
- 62 Starnes V A, Bowdish M E, Woo M S et al.. A decade of living lobar lung transplantation: recipient outcomes. J Thorac Cardiovasc Surg. 2004; 127 114-122
- 63 Rosbe K W, Jones D T, Rahbar R, Lahiri T, Auerbach A D. Endoscopic sinus surgery in cystic fibrosis: do patients benefit from surgery?. Int J Pediatr Otorhinolaryngol. 2001; 61 113-119
- 64 Holzmann D, Speich R, Kaufmann T et al.. Effects of sinus surgery in patients with cystic fibrosis after lung transplantation: a 10-year experience. Transplantation. 2004; 77 134-136
- 65 Leung M K, Rachakonda L, Weill D et al.. Effects of sinus surgery on lung transplantation outcomes in cystic fibrosis. Am J Rhinol. 2008; 22 192-196
- 66 Schwebel C, Pin I, Barnoud D et al.. Prevalence and consequences of nutritional depletion in lung transplant candidates. Eur Respir J. 2000; 16 1050-1055
- 67 Mozzillo E, Franzese A, Valerio G et al.. One-year glargine treatment can improve the course of lung disease in children and adolescents with cystic fibrosis and early glucose derangements. Pediatr Diabetes. 2009; 10 162-167
- 68 Stringer D A, Sprigg A, Juodis E et al.. The association of cystic fibrosis, gastroesophageal reflux, and reduced pulmonary function. Can Assoc Radiol J. 1988; 39 100-102
- 69 Brodzicki J, Trawińska-Bartnicka M, Korzon M. Frequency, consequences and pharmacological treatment of gastroesophageal reflux in children with cystic fibrosis. Med Sci Monit. 2002; 8 CR529-CR537
- 70 Benden C, Aurora P, Curry J, Whitmore P, Priestley L, Elliott M J. High prevalence of gastroesophageal reflux in children after lung transplantation. Pediatr Pulmonol. 2005; 40 68-71
- 71 Blondeau K, Mertens V, Vanaudenaerde B A et al.. Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection. Eur Respir J. 2008; 31 707-713
- 72 Palmer S M, Miralles A P, Howell D N, Brazer S R, Tapson V F, Davis R D. Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation. Chest. 2000; 118 1214-1217
- 73 D'Ovidio F, Mura M, Ridsdale R et al.. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. Am J Transplant. 2006; 6 1930-1938
- 74 Dellon E S, Morgan D R, Mohanty S P, Davis K, Aris R M. High incidence of gastric bezoars in cystic fibrosis patients after lung transplantation. Transplantation. 2006; 81 1141-1146
- 75 Morton J R, Ansari N, Glanville A R, Meagher A P, Lord R V. Distal intestinal obstruction syndrome (DIOS) in patients with cystic fibrosis after lung transplantation. J Gastrointest Surg. 2009; 13 1448-1453
- 76 Yates B, Murphy D M, Fisher A J et al.. Pseudomembranous colitis in four patients with cystic fibrosis following lung transplantation. Thorax. 2007; 62 554-556
- 77 Bhardwaj S, Canlas K, Kahi C et al.. Hepatobiliary abnormalities and disease in cystic fibrosis: epidemiology and outcomes through adulthood. J Clin Gastroenterol. 2009; , Jun 11. [Epub ahead of print]
- 78 Nash K L, Allison M E, McKeon D et al.. A single centre experience of liver disease in adults with cystic fibrosis 1995-2006. J Cyst Fibros. 2008; 7 252-257
- 79 Klima L D, Kowdley K V, Lewis S L, Wood D E, Aitken M L. Successful lung transplantation in spite of cystic fibrosis-associated liver disease: a case series. J Heart Lung Transplant. 1997; 16 934-938
- 80 King S J, Topliss D J, Kotsimbos T et al.. Reduced bone density in cystic fibrosis: DeltaF508 mutation is an independent risk factor. Eur Respir J. 2005; 25 54-61
- 81 Quattrucci S, Rolla M, Cimino G et al.. Lung transplantation for cystic fibrosis: 6-year follow-up. J Cyst Fibros. 2005; 4 107-114
- 82 Spahr J E, Love R B, Francois M, Radford K, Meyer K C. Lung transplantation for cystic fibrosis: current concepts and one center's experience. J Cyst Fibros. 2007; 6 334-350
- 83 Meyer K C. The Role of Neutrophils in Transplantation: Immunobiology of Organ Transplantation. New York; Kluwer/Plenum 2004: 493-507
- 84 Krenn K, Klepetko W, Taghavi S, Paulus P, Aharinejad S. Vascular endothelial growth factor increases pulmonary vascular permeability in cystic fibrosis patients undergoing lung transplantation. Eur J Cardiothorac Surg. 2007; 32 35-41
- 85 Dupuis R E, Sredzienski E S. Tobramycin pharmacokinetics in patients with cystic fibrosis preceding and following lung transplantation. Ther Drug Monit. 1999; 21 161-165
- 86 Saint-Marcoux F, Knoop C, Debord J et al.. Pharmacokinetic study of tacrolimus in cystic fibrosis and non-cystic fibrosis lung transplant patients and design of Bayesian estimators using limited sampling strategies. Clin Pharmacokinet. 2005; 44 1317-1328
- 87 Knoop C, Vervier I, Thiry P et al.. Cyclosporine pharmacokinetics and dose monitoring after lung transplantation: comparison between cystic fibrosis and other conditions. Transplantation. 2003; 76 683-688
- 88 Berge M, Guillemain R, Boussaud V et al.. Voriconazole pharmacokinetic variability in cystic fibrosis lung transplant patients. Transpl Infect Dis. 2009; 11 211-219
- 89 Cadena J, Levine D J, Angel L F et al.. Antifungal prophylaxis with voriconazole or itraconazole in lung transplant recipients: hepatotoxicity and effectiveness. Am J Transplant. 2009; 9 2085-2091
- 90 Veith F J, Kamholz S L, Mollenkopf F P, Montefusco C M. Lung transplantation 1983. Transplantation. 1983; 35 271-278
- 91 Date H, Trulock E P, Arcidi J M, Sundaresan S, Cooper J D, Patterson G A. Improved airway healing after lung transplantation: an analysis of 348 bronchial anastomoses. J Thorac Cardiovasc Surg. 1995; 110 1424-1432, discussion 1432–1433
- 92 Weder W, Inci I, Korom S et al.. Airway complications after lung transplantation: risk factors, prevention and outcome. Eur J Cardiothorac Surg. 2009; 35 293-298, discussion 298
- 93 Moreno P, Alvarez A, Algar F J et al.. Incidence, management and clinical outcomes of patients with airway complications following lung transplantation. Eur J Cardiothorac Surg. 2008; 34 1198-1205
- 94 Vos R, Vanaudenaerde B M, Geudens N, Dupont L J, Van Raemdonck D E, Verleden G M. Pseudomonal airway colonisation: risk factor for bronchiolitis obliterans syndrome after lung transplantation?. Eur Respir J. 2008; 31 1037-1045
- 95 Bonvillain R W, Valentine V G, Lombard G, LaPlace S, Dhillon G, Wang G. Post-operative infections in cystic fibrosis and non-cystic fibrosis patients after lung transplantation. J Heart Lung Transplant. 2007; 26 890-897
- 96 Gottlieb J, Mattner F, Weissbrodt H et al.. Impact of graft colonization with gram-negative bacteria after lung transplantation on the development of bronchiolitis obliterans syndrome in recipients with cystic fibrosis. Respir Med. 2009; 103 743-749
- 97 Sarahrudi K, Estenne M, Corris P et al.. International experience with conversion from cyclosporine to tacrolimus for acute and chronic lung allograft rejection. J Thorac Cardiovasc Surg. 2004; 127 1126-1132
- 98 Gerhardt S G, McDyer J F, Girgis R E, Conte J V, Yang S C, Orens J B. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med. 2003; 168 121-125
- 99 Verleden G M, Dupont L J. Azithromycin therapy for patients with bronchiolitis obliterans syndrome after lung transplantation. Transplantation. 2004; 77 1465-1467
- 100 Yates B, Murphy D M, Forrest I A et al.. Azithromycin reverses airflow obstruction in established bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 2005; 172 772-775
- 101 Gottlieb J, Szangolies J, Koehnlein T, Golpon H, Simon A, Welte T. Long-term azithromycin for bronchiolitis obliterans syndrome after lung transplantation. Transplantation. 2008; 85 36-41
- 102 Mertens V, Blondeau K, Pauwels A et al.. Azithromycin reduces gastroesophageal reflux and aspiration in lung transplant recipients. Dig Dis Sci. 2009; 54 972-979
- 103 Egan T M, Detterbeck F C, Mill M R et al.. Improved results of lung transplantation for patients with cystic fibrosis. J Thorac Cardiovasc Surg. 1995; 109 224-234, discussion 234–235
- 104 Williams T J, Patterson G A, McClean P A, Zamel N, Maurer J R. Maximal exercise testing in single and double lung transplant recipients. Am Rev Respir Dis. 1992; 145 101-105
- 105 Levy R D, Ernst P, Levine S M et al.. Exercise performance after lung transplantation. J Heart Lung Transplant. 1993; 12(1 Pt 1) 27-33
- 106 Egan T M, Detterbeck F C, Mill M R et al.. Long term results of lung transplantation for cystic fibrosis. Eur J Cardiothorac Surg. 2002; 22 602-609
- 107 Vermeulen K M, van der Bij W, Erasmus M E, Duiverman E J, Koëter G H, TenVergert E M. Improved quality of life after lung transplantation in individuals with cystic fibrosis. Pediatr Pulmonol. 2004; 37 419-426
- 108 Choong C K, Meyers B F. Quality of life after lung transplantation. Thorac Surg Clin. 2004; 14 385-407
- 109 Smeritschnig B, Jaksch P, Kocher A et al.. Quality of life after lung transplantation: a cross-sectional study. J Heart Lung Transplant. 2005; 24 474-480
Keith C MeyerM.D. M.S.
Section of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health
K4/910 CSC, 600 Highland Ave., Madison, WI 53792-9988
Email: kcm@medicine.wisc.edu