Should cystic fibrosis patients infected with Burkholderia cepacia complex be listed for lung transplantation?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether lung transplantation remained a beneficial treatment for cystic fibrosis (CF) patients infected or colonized with Burkholderia cepacia complex (BCC) prior to lung transplantation (LTx). Of the 25 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the five studies were clearly in favor of maintaining access to LTx lists for BCC infected or colonized CF patients. In other words, access to LTx should not be denied to BCC infected CF patients in that the beneficial effects of LTx do not differ with respect to non-infected patients: comparison showed neither a difference in survival nor a higher mortality risk. However, results would differ for Burkholderia cenocepacia infected CF patients prior to LTx: both short- and long-term survival are significantly lower when B. cenocepacia infected patients are compared to other BCC infected patients or non-infected patients. Hence, current evidence shows that careful screening of all BCC suspected CF patients and risk-aware multidisciplinary management should be achieved before listing patients for LTx. This would allow identification of different bacterial species (in particular, B. cenocepacia) present and optimize lung transplantation survival outcomes. (c) 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.