A lung transplant can benefit patients with non-cystic fibrosis bronchiectasis at advanced stages, and should be considered by physicians as a therapeutic option, a study found.
Findings show that lung transplantation provides considerably good clinical outcomes in terms of patient’s survival and lung function. The study, “Outcomes of lung transplantation in adults with bronchiectasis,” was published in the journal BMC Pulmonary Medicine.
Although lung transplants are an option for treating severe bronchiectasis not due to cystic fibrosis, there isn’t a lot of data on the results and outcomes of this procedure in these patients.
There is also little information on the impact of Pseudomonas aeruginosa infection — a common infection in bronchiectasis patients, associated with more severe disease — on both short- and long-term outcomes of lung transplants.
Since increasing numbers of bronchiectasis cases have been reported, there is an urgent need to understand the benefits and risks of lung transplants for this group of patients.
As such, researchers from Newcastle University and Freeman Hospital in the U.K. conducted an observational, retrospective study to analyze the outcomes of patients who received a lung transplant at Freeman Hospital between 1990 and 2013.
Most transplants were done using a procedure called bilateral single sequential lung transplantation, considered to be the most appropriate for bronchiectasis patients. In this procedure, each lung is transplanted one at a time.
A total of 42 patients (mean age at transplant of 47.1 years) with non-cystic fibrosis bronchiectasis were included, who had moderate to severe disease prior to the procedure.
Researchers compared the survival rates between bronchiectasis patients and those with other conditions, who had also received a lung transplant. Lung function and lung infection profiles prior to the transplant were also compared with the patients’ outcomes after the transplant.
Results showed that overall, after the transplant, lung function improved, as measured by the forced expiratory volume in one second, from a mean of 0.71 L to 2.56 L one year post-transplant, and to 2.36 L at 10 years post-transplant.
In contrast, renal function — measured through serum creatinine levels — worsened in all patients one year after transplant. However, among the patients still alive at data capture (14 patients of the initial 42), none had required hemodialysis or had undergone a kidney transplant.
Importantly, survival rates in the first 10 years following the transplant were equivalent between bronchiectasis patients and those with other conditions.
According to the team, post-transplant outcomes were excellent, with a more than 50% survival rate at five years following the transplant. Specifically, survival was 74% at one year, 64% at three years, 61% at five years, and 48% at 10 years after the surgery.
Although the cause of death was not possible to determine for all patients, sepsis — a generalized and potentially life-threatening inflammation in response to infection — was the most common cause, accounting for 38 percent of all recorded cases.
Prior to transplant, most patients had more than one pathogenic microorganism in their lung mucus (sputum), with P. aeruginosa infection being the most common — present in 45 percent of patients at the time of surgery.
One year after the transplant, most patients no longer tested positive for lung infections, but in those who did, P. aeruginosa was again the most common bacteria present, in 21% of the cases.
Future studies should assess the rejection rates and prognostic implications associated with Pseudomonas infection, the researchers said.
“Lung transplantation for end-stage BR [bronchiectasis] is a useful therapeutic option, with good survival and lung function outcomes. Survival values were similar to other bilateral lung transplants at our centre,” the team said, adding that “physicians should consider transplantation as an option in those with severe bronchiectasis.”
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