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Lung transplants in cystic fibrosis patients with life-threatening bacteria sparks debate at ISHLT
April 14, 2008During Wednesday's Satellite Symposium 3: The Challenges of Lung Transplantation in Cystic Fibrosis (CF) at the International Society of Heart and Lung Transplantation (ISHLT) Annual Meeting & Scientific Sessions, clinicians and researchers discussed some of the unique challenges in achieving excellent lung transplant outcomes in patients with CF.
A highlight of the session was the concluding debate: Burkholderia Cenocepacia is an Absolute Contradiction to Transplantation between Duane Davis, MD, Duke University Medical Center, Durham, NC and Redha R. Souilemas, MD, European Georges Pompidou Hospital, Paris.
Cystic Fibrosis, Burkholderia Cenocepacia and Lung Transplantation
Patients with life threatening lung disease due to CF have a lot to gain by lung transplantation. Compared to other possible indications for transplant, patients with CF have, in general, the best outcomes, and a successful transplant can mean a significant increase in lifespan and a huge improvement in quality of life.
A hallmark of advanced CF lung disease is repeated severe chest infections. In most cases these infections are responsive to treatment with powerful antibiotics and their presence does not influence the outcomes after transplant in CF patients.
However in 5 percent of patients with CF, bacteria called Burkholderia cenocepacia infects the lungs before transplant. This infection is very resistant to antibiotics and if it returns after the transplant surgery it is extremely difficult to control and can be life threatening.
It is estimated that less than only 30 percent of patients with Burkholderia cenocepacia who receive lung transplants survive beyond five years with many dying very early after transplant due to recurrence of the severe infection with this bacteria. In comparison, CF patients without this infection can expect 5-year post-transplant survival of up to 70 percent on average. The debate within the transplant community is whether or not to allocate donor lungs to patients with Burkholderia cenocepacia knowing that the success rate is much worse than in CF patients without this infection.
According to Dr. Davis, lung transplants should not be performed on CF patients with Burkholderia cenocepacia until new research indicates a way to achieve better early results by better control of the infection. He went on to say new ways of treating patients with Burkholderia cenocepacia should be examined in clinical trials with a hypothesis, careful data collection and safety monitoring. Only after such research approaches have generated a clinical advance in treatment of this infection should lung transplants in CF patients with Burkholderia cenocepacia be performed in the same manner as those who do not have the disease.
Representing the counter argument, Dr. Souilemas said he believes it is very difficult to choose between two patients who need the same procedure. "Medicine is science and art," said Dr. Souilemas in the debate. During his argument, Dr. Souilemas also presented information on reversible factors other than the infection itself, which may contribute to the patients' poor health before receiving a lung transplant, and thus contribute to poor outcomes. Dr. Souilemas finished his debate by proposing that each patient be viewed as a potential lung transplant candidate and encouraged clinicians to attempt to transplant each as successfully as possible.
In the end, both physicians agreed that more careful research into transplants in CF patients with Burkholderia cenocepacia would improve success rates for these patients.
International Society for Heart and Lung Transplantation
Patients with life threatening lung disease due to CF have a lot to gain by lung transplantation. Compared to other possible indications for transplant, patients with CF have, in general, the best outcomes, and a successful transplant can mean a significant increase in lifespan and a huge improvement in quality of life.
A hallmark of advanced CF lung disease is repeated severe chest infections. In most cases these infections are responsive to treatment with powerful antibiotics and their presence does not influence the outcomes after transplant in CF patients.
However in 5 percent of patients with CF, bacteria called Burkholderia cenocepacia infects the lungs before transplant. This infection is very resistant to antibiotics and if it returns after the transplant surgery it is extremely difficult to control and can be life threatening.
It is estimated that less than only 30 percent of patients with Burkholderia cenocepacia who receive lung transplants survive beyond five years with many dying very early after transplant due to recurrence of the severe infection with this bacteria. In comparison, CF patients without this infection can expect 5-year post-transplant survival of up to 70 percent on average. The debate within the transplant community is whether or not to allocate donor lungs to patients with Burkholderia cenocepacia knowing that the success rate is much worse than in CF patients without this infection.
According to Dr. Davis, lung transplants should not be performed on CF patients with Burkholderia cenocepacia until new research indicates a way to achieve better early results by better control of the infection. He went on to say new ways of treating patients with Burkholderia cenocepacia should be examined in clinical trials with a hypothesis, careful data collection and safety monitoring. Only after such research approaches have generated a clinical advance in treatment of this infection should lung transplants in CF patients with Burkholderia cenocepacia be performed in the same manner as those who do not have the disease.
Representing the counter argument, Dr. Souilemas said he believes it is very difficult to choose between two patients who need the same procedure. "Medicine is science and art," said Dr. Souilemas in the debate. During his argument, Dr. Souilemas also presented information on reversible factors other than the infection itself, which may contribute to the patients' poor health before receiving a lung transplant, and thus contribute to poor outcomes. Dr. Souilemas finished his debate by proposing that each patient be viewed as a potential lung transplant candidate and encouraged clinicians to attempt to transplant each as successfully as possible.
In the end, both physicians agreed that more careful research into transplants in CF patients with Burkholderia cenocepacia would improve success rates for these patients.
International Society for Heart and Lung Transplantation
Cystic Fibrosis Current Events and Cystic Fibrosis News RSSNew approach to treating cystic fibrosis lung infection shows promise
Researchers at the University of Calgary have found a new method of fighting severe lung infections in people with cystic fibrosis (CF). These findings are published in Proceedings of the National Academy of Science USA, this week.
Protein opens hope of treatment for cystic fibrosis patients
Scientists have finally identified a direct role for the missing protein that leaves cystic fibrosis patients open to attack from lung-damaging bacteria, the main reason most of them die before their 35th birthday, scientists heard today (Thursday 11 September 2008) at the Society for General Microbiology's Autumn meeting being held this week at Trinity College, Dublin.
Rattlesnake-type poisons used by superbug bacteria to beat our defenses
Colonies of hospital superbugs can make poisons similar to those found in rattlesnake venom to attack our bodies' natural defences, scientists heard today (Monday 8 September 2008) at the Society for General Microbiology's Autumn meeting being held this week at Trinity College, Dublin.
Clearing the airways in cystic fibrosis
By manipulating the machinery used by our cells for quality control, researchers from the University of Pittsburgh have found a way to restore the function of cystic fibrosis (CF) airway cells.
PTC124 shows activity in cystic fibrosis; Phase 2 proof-of-concept data published in Lancet
New phase 2 data published today in The Lancet show that the investigational oral drug PTC124 demonstrates activity in nonsense-mutation cystic fibrosis (CF). The data show that treatment with PTC124 results in statistically significant improvements in the chloride channel function of patients with nonsense-mutation CF. The study was conducted at the Hadassah Hebrew University Hospital in Jerusalem, Israel and sponsored by PTC Therapeutics (PTC).
Breaking the 'mucus barrier' with a new drug delivery system
Chemical engineers from Johns Hopkins University have broken the "mucus barrier," engineering the first drug-delivery particles capable of passing through human mucus - regarded by many as nearly impenetrable - and carrying medication that could treat a range of diseases. Those conditions include lung cancer, cervical cancer and cystic fibrosis, the research noted in a presentation scheduled for the 236th National Meeting of the American Chemical Society.
NIH scientists find a novel mechanism that controls the development of autoimmunity
Scientists at the National Institutes of Health (NIH) have found a mechanism in the immune systems of mice that can lead to the development of autoimmune disease when turned off.
Researchers discover cell's 'quality control' mechanism
Researchers in Japan and Canada have discovered a key component of the quality control mechanism that operates inside human cells - sometimes too well. The breakthrough has significant implications for the development of new treatments for cystic fibrosis (CF) and some other hereditary diseases, the researchers say. Their results were published July 25 in the journal Science.
Most generalists reluctant to provide primary care for young adults with chronic illness
The majority of general internists and pediatricians in the United States are not comfortable serving as primary care providers for young adults with complex chronic illnesses that originate during childhood, according to findings from a new national survey.
Mucous breakthrough in mice holds promise for cystic fibrosis
A London, Canada scientist studying cystic fibrosis (CF) has successfully corrected the defect which causes the overproduction of intestinal mucous in mice.
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