Division of Anesthesia and Critical Care Medicine, Department of Surgical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy -
Division of Respirology and Critical Care Medicine, Department of Medicine, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
Minerva Anestesiol. 2020 Jun;86(6):617-626. doi: 10.23736/S0375-9393.20.13840-9. Epub 2020 Jan 27.
Normothermic ex-vivo lung perfusion (EVLP) limits organ donor shortage by potentially using high-risk donor lungs. Microbial burden reduction has been demonstrated after EVLP using antibiotic prophylaxis with imipenem. However, no data have been published on the clinical consequences of the potential residual bacterial burden.
Imipenem concentration was measured every hour (T0 to T6) in the lung perfusate and at the end of EVLP (Tf) in biopsies. The antimicrobial activity of perfusate at T1 and Tf against E. coli and K. pneumoniae was evaluated. Lungs were distinguished: no bacterial species in recipients and donors (donor-/recipient-); bacterial species isolated from donors and not from recipients (donor+/recipient-); same bacterial species in both recipients and donors (donor+/recipient+). Interleukin 6 (IL-6) and IL-8 concentrations in lung perfusate, clinical pulmonary infection score (CPIS) and primary graft dysfunction (PGD) were evaluated.
Imipenem concentration in perfusate decreased over time. T1 and Tf perfusates exhibited bactericidal activity against E. coli and K. pneumoniae. Overall, T1 perfusates yielded higher bactericidal titers (BTs) than Tf. The donor+/recipient+ group (26% of cases) had higher IL-6 and IL-8 in perfusate and higher CPIS.
Recipients with the same bacterial species isolated in their donors had higher risk of pulmonary inflammation and early post-transplant pneumonia. Improvements in antimicrobial strategies during EVLP are warranted to minimize the consequences of donor associated respiratory infection.
常温离体肺灌注（EVLP）通过潜在地使用高危供体肺来限制器官捐献者的短缺。使用亚胺培南进行抗生素预防已经证明可以降低 EVLP 后的微生物负荷。然而，关于潜在残留细菌负荷的临床后果尚未发表数据。
在肺灌洗液中每小时（T0 至 T6）和 EVLP 结束时（Tf）测量亚胺培南浓度（T0 至 T6），并在 T1 和 Tf 时评估灌洗液对大肠杆菌和肺炎克雷伯菌的抗菌活性。将肺分为：受者和供者均无细菌种类（供体-/受体-）；供体中分离出但受体中未分离出的细菌种类（供体+/受体-）；受体和供体中存在相同的细菌种类（供体+/受体+）。评估肺灌洗液中白细胞介素 6（IL-6）和白细胞介素 8（IL-8）浓度、临床肺部感染评分（CPIS）和原发性移植物功能障碍（PGD）。
灌洗液中亚胺培南浓度随时间降低。T1 和 Tf 灌洗液对大肠杆菌和肺炎克雷伯菌具有杀菌活性。总体而言，T1 灌洗液的杀菌滴度（BT）高于 Tf。供体+/受体+组（占病例的 26%）灌洗液中的 IL-6 和 IL-8 更高，CPIS 更高。
受体与供体中分离出相同细菌种类的患者发生肺部炎症和移植后早期肺炎的风险更高。需要改进 EVLP 期间的抗菌策略，以最大限度地降低供体相关呼吸道感染的后果。
