BackgroundLong-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.MethodsPatients 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.ResultsCLAD-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).ConclusionPA eradication after LTx improves CLAD-free and graft survival and maintains pulmonary function. Therefore, early PA detection and eradication should be pursued.

We report the case of a 50-year-old woman with anorexigen-induced pulmonary arterial hypertension treated with epoprostenol, who presented with Trousseau’s sign, leading to the diagnosis of severe hypocalcemia for which substitution was started (initially orally, followed by intravenous substitution). After further analysis, we assume that epoprostenol-induced diarrhea caused malabsorption (as other reasons were excluded), leading to nutritional osteomalacia with secondary hyperparathyroidism. We discovered that even more severe hypocalcemia was induced by the treatment with the anti-osteoporotic drug denosumab, which was started after the diagnosis of osteoporosis on bone densitometry. In our opinion, clinicians have to be aware that in patients with malabsorption, antiresorptive therapy can induce dangerous and even life-threatening hypocalcemia, even in patients with normal renal function.

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