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A positive donor gram stain does not predict outcome following lung transplantation
David Weill1, Gerald C Dey, R Alan Hicks
1Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. dweill@uab.edu
Background:
Many potential lung donors are excluded on the basis of a positive donor gram stain (DGS). We examined the association between a positive DGS and the probability of post-operative recipient pneumonia in the first 30 days.
Methods:
Ninety lung transplants (80 with a non-septic pre-transplant diagnosis) from 60 consecutive donors were evaluated for post-operative pneumonia (defined as a compatible clinical syndrome with fever, leukocytosis, chest X-ray abnormalities or histologic evidence obtained by transbronchial biopsy). DGS, white blood cell quantity, CXR and PaO(2)/FIO(2) (P/F) ratio were compared with immediate and 24-hour P/F ratio, length of mechanical ventilation and incidence of pneumonia. All recipients received standard prophylactic anti-bacterial coverage. Patients not surviving 30 days (n = 3) were excluded from this study, but none had evidence of pneumonia either by bronchoalveolar lavage (BAL), transbronchial biopsy or autopsy.
Results:
Fourteen (16%) of our 87 recipients developed pneumonia in the first 30 days after transplant. Of the 43 patients with a positive DGS, 5 (12%) developed pneumonia, compared to 9 of 44 (20%) with a negative DGS (p = 0.26). The mean post-operative P/F ratio (315 +/- 47 with a positive DGS, p = 0.3) and length of mechanical ventilation (2 days in each group) did not differ significantly between the negative and positive DGS groups.
Conclusions:
In the current era of lung transplantation, DGS does not predict the development of early post-operative pneumonia and does not affect oxygenation or duration of mechanical ventilation; therefore, its role should be diminished when judging donor lung suitability.
Insights
A positive donor gram stain (DGS) does not predict early pneumonia after lung transplantation. Donor lung suitability should be re-evaluated, as DGS does not impact recipient outcomes.
Area of Science:
- Pulmonology
- Transplant Surgery
- Infectious Disease
Background:
- Donor gram stain (DGS) positivity often excludes potential lung donors.
- The impact of DGS on post-operative recipient pneumonia requires further investigation.
Purpose of the Study:
- To determine if a positive DGS is associated with an increased risk of early post-operative pneumonia in lung transplant recipients.
Main Methods:
- Retrospective analysis of 90 lung transplants from 60 donors.
- Pneumonia defined by clinical criteria and confirmed by biopsy.
- Comparison of DGS status with post-operative oxygenation (P/F ratio) and mechanical ventilation duration.
Main Results:
- 16% of recipients developed pneumonia within 30 days.
- No significant difference in pneumonia incidence between positive (12%) and negative (20%) DGS groups (p=0.26).
- Similar post-operative P/F ratios and mechanical ventilation durations in both groups.
Conclusions:
- Donor gram stain (DGS) does not predict early post-operative pneumonia in lung transplant recipients.
- DGS status does not influence oxygenation or ventilation duration.
- The utility of DGS in donor lung selection warrants re-evaluation.