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Eur J Cardiothorac Surg 2003;24:601-607
© 2003 Elsevier Science NL

Bacterial colonization of the donor lower airways is a predictor of poor outcome in lung transplantation

Cardiopulmonary Transplantation Unit, Freeman Hospital, Newcastle upon Tyne, UK

Received 17 March 2003; received in revised form 10 July 2003; accepted 14 July 2003.

^* Corresponding author. Department of Surgery, Medical School, University of Newcastle, Framlington Place, Newcastle upon Tyne NE2 4HH, UK. Tel.: +44-191-222-7156; fax: +44-191-222-8514
e-mail: avlonitis{at}hotmail.com

Objective: At the time of lung transplant, we routinely perform bronchoalveolar lavage (BAL) of the donor lungs on the recipient operating table immediately before implantation, for bacterial and fungal cultures. We sought to determine whether the results correlate with the outcome. Methods: We retrospectively analysed 115 consecutive cadaveric lung transplants (single lung: 42; bilateral lung: 63; heart–lung: 10) performed over 4 years. Results: Fifty-three (46%) grafts had positive BAL (bacteria: 33; fungus: 10; mixed: 10) and 62 (54%) were negative. Recipients with donor BAL culture positive for bacteria had lower mean oxygenation index in the first 6 h compared with those with negative bacterial culture (36.5±14.73 vs. 44.1±16.79 kPa) (P=0.019). They also had longer median intensive treatment unit stay (2.5 vs. 1.5 days) (P=0.035), and median time of mechanical ventilation (37.5 vs. 23.0 h) (P=0.008), as well as inferior 6-month, 1-year, 2-year and 4-year cumulative survival (79, 77, 74, 60% vs. 93, 92, 88, 79% respectively) (P=0.04). There was no difference in the above parameters between recipients with Gram-negative (n=18) and recipients with Gram-positive bacteria (n=19) in the donor BAL. Incidence of acute rejection within the first 2 weeks and time of onset of bronchiolitis obliterans syndrome (BOS) were similar in the bacteria-positive and bacteria-negative groups. Recipients with donor BAL positive for fungi alone had similar outcome with the negatives. There was no difference in the donor oxygenation index and age, recipient age, transplant type and ischaemic time between compared groups. There was a significant difference in the median length of donor mechanical ventilation between donors with Gram-positive and donors with Gram-negative bacteria in the BAL (24 vs. 48 h) (P=0.01), as well as between donors with fungi alone in the BAL and donors with negative BAL (67 vs. 48 h) (P=0.04). Conclusions: Donor lungs with lower airways colonized with bacteria result in inferior recipient outcome. Bacterial colonization of the donor lower airways could therefore be used as a marker of donor lung injury, but evidence from a prospective study is necessary.

Key Words: Lung transplantation • Bronchoalveolar lavage • Bacteria • Fungi

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