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

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Long-term survival after lung transplantation (LTx) is hampered by development of chronic lung allograft dysfunction (CLAD). Pseudomonas aeruginosa (PA) is an established risk factor for CLAD. Therefore, we investigated the effect of PA eradication on CLAD-free and graft survival.Patients who underwent first LTx between 07/1991-02/2016 and were free from CLAD, were retrospectively classified according to PA presence in respiratory samples between 09/2011 and 09/2016. PA positive patients were subsequently stratified according to success of PA eradication following targeted antibiotic treatment. CLAD-free and graft survival were compared between PA positive and PA negative patients; and between patients with or without successful PA eradication. In addition, pulmonary function was assessed during the first year following PA isolation in both groups.CLAD-free survival of PA negative patients (n=443) was longer compared to PA positive patients (n=95) (p=0.045). Graft survival of PA negative patients (n=443, 82%) was better compared to PA positive patients (n=95, 18%) (p<0.0001). Similarly, PA eradicated patients demonstrated longer CLAD-free survival compared to patients with persistent PA (p=0.018). Pulmonary function was higher in successfully PA eradicated patients compared to unsuccessfully eradicated patients (p=0.035).PA eradication after LTx improves CLAD-free and graft survival and maintains pulmonary function. Therefore, early PA detection and eradication should be pursued.

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