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Impact of donor lung organisms on post-lung transplant pneumonia

Pramod N Bonde1, Nishant D Patel, Marvin C Borja

  • 1Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|January 10, 2006
PubMed
Abstract

Insights

Donor bronchial organisms do not predict post-lung transplant pneumonia (PTP). Routine donor cultures are not reliable indicators for PTP development, suggesting a need to re-evaluate donor acceptance criteria in lung transplantation.

Area of Science:

  • Medicine
  • Transplantation Immunology
  • Infectious Diseases

Background:

  • Donor-to-host transmission of organisms can lead to recipient pneumonia, impacting donor lung utilization.
  • Routine donor bronchial aspiration and culture are employed to assess infection risk in lung transplantation.

Purpose of the Study:

  • To investigate the correlation between donor bronchial organisms and the incidence of post-lung transplant pneumonia (PTP).
  • To evaluate the predictive value of donor bronchial cultures for recipient outcomes after lung transplantation.

Main Methods:

  • A retrospective review of 71 consecutive lung transplant recipients (excluding pediatric and short-term survivors) from August 1998 to August 2001.
  • Donor bronchial aspirates were cultured, and PTP was diagnosed based on clinical, radiological, and microbiological criteria within 30 days post-transplant.

Main Results:

  • Organisms were identified in 89% of donors, frequently polymicrobial. Staphylococcus and Streptococcus were the most common species.
  • Post-lung transplant pneumonia (PTP) occurred in 41% of recipients, with Pseudomonas species being most prevalent.
  • Donor organisms showed low specificity (0.04) for predicting PTP and were negatively correlated with its development; PTP independently predicted mortality.

Conclusions:

  • The presence of donor bronchial organisms does not reliably predict the development of PTP.
  • Current donor acceptance criteria, particularly those related to bronchial flora, may require re-examination to optimize donor lung utilization and recipient outcomes.

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