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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Impact of perioperative airway pathogens on living-donor lobar lung transplantation outcomes
Hiromi Oda1,2, Satona Tanaka3, Toyofumi F Chen-Yoshikawa1,4
1Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto City, Kyoto, 606-8507, Japan.
Purpose:
To elucidate the clinical impact of pathogenic organism (PO) positivity early after transplantation, we evaluated the impact of perioperative airway POs on outcomes after living-donor lobar lung transplantation (LDLLT), where the graft airway is supposed to be sterile from a healthy donor.
Method:
A retrospective review of 67 adult LDLLT procedures involving 132 living donors was performed. Presence of POs in the recipients' airways was evaluated preoperatively and postoperatively in intensive-care units.
Results:
POs were detected preoperatively in 13 (19.4%) recipients. No POs were isolated from the donor airways at transplantation. POs were detected in 39 (58.2%) recipients postoperatively; most were different from the POs isolated preoperatively. Postoperative PO isolation was not associated with short-term outcomes other than prolonged postoperative ventilation. The 5-year overall survival was significantly better in the PO-negative group than in the PO-positive group (89.1% vs. 63.7%, P = 0.014). In the multivariate analysis, advanced age (hazard ratio [HR]: 1.041 per 1-year increase, P = 0.033) and posttransplant PO positivity in the airway (HR: 3.684, P = 0.019) significantly affected the survival.
Conclusions:
The airways of the living-donor grafts were microbiologically sterile. PO positivity in the airway early after transplantation negatively impacted long-term outcomes.
Insights
Early airway pathogenic organism (PO) positivity after living-donor lobar lung transplantation (LDLLT) negatively impacts long-term survival. Donor airways remain sterile, indicating recipient-acquired infections are the source of POs.
Area of Science:
- Transplantation immunology
- Microbiology in clinical practice
- Surgical outcomes research
Background:
- Living-donor lobar lung transplantation (LDLLT) involves a sterile graft airway.
- Understanding early pathogenic organism (PO) presence is crucial for patient outcomes.
Purpose of the Study:
- To assess the clinical impact of perioperative airway PO positivity on outcomes after LDLLT.
- To determine if early PO detection affects survival post-transplant.
Main Methods:
- Retrospective review of 67 adult LDLLT procedures and 132 living donors.
- Evaluation of PO presence in recipient airways preoperatively and postoperatively in the ICU.
Main Results:
- No POs were found in donor airways; 19.4% of recipients had preoperative POs.
- Postoperative POs detected in 58.2% of recipients, often different from preoperative strains.
- Postoperative PO positivity was linked to prolonged ventilation and significantly reduced 5-year survival (63.7% vs. 89.1%).
Conclusions:
- Living-donor lung grafts maintain airway sterility.
- Early postoperative airway PO positivity is a significant negative predictor of long-term survival in LDLLT recipients.
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