Fumagalli Jacopo, Punzi Veronica, Scaravilli Vittorio, Passamonti Serena M, Morlacchi Letizia C, Rossetti Valeria, Maraschini Anna, Matinato Caterina, Brivio Margherita, Righi Ilaria, Blasi Francesco, Bandera Alessandra, Rosso Lorenzo, Panigada Mauro, Zanella Alberto, Grasselli Giacomo
Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Dipartimento of Anesthesia, Critical Care, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
J Heart Lung Transplant. 2024 Aug;43(8):1288-1297. doi: 10.1016/j.healun.2024.04.005. Epub 2024 Apr 25.
Inconsistent data exists regarding the risk factors for bronchoalveolar lavage (BAL) positivity in lung donors, the incidence of donor-derived infections (DDI), and the effect of BAL positivity on lung transplant (LuTx) recipients' outcome.
A retrospective analysis was conducted on consecutive LuTx at a single center from January 2016 to December 2022. Donors' data, including characteristics, graft function and BAL samples were collected pre-procurement. Recipients underwent BAL before LuTx and about the 3rd, 7th and 14th day after LuTx. A DDI was defined as BAL positivity (bacterial growth ≥10 colony forming units) for identical bacterial species between donor and recipient. Recipients' pre-operative characteristics, intra-operative management, and post-operative outcomes were assessed. Two recipient cohorts were identified based on lung colonization status before undergoing LuTx.
Out of 188 LuTx procedures performed, 169 were analyzed. Thirty-six percent of donors' BAL tested positive. Donors' characteristics and graft function at procurement were not associated with BAL positivity. Fourteen DDI were detected accounting for 23% of recipients receiving a graft with a positive BAL. Only among uncolonized recipients, receiving a graft with positive BAL is associated with higher likelihood of requiring invasive ventilation at 72 hours after LuTx on higher positive end-expiratory pressure levels having lower PaO/FiO, prolonged duration of mechanical ventilation and longer ICU stay. No difference in hospital length of stay was observed.
Receiving a graft with a positive BAL, which is poorly predicted by donors' characteristics, carries the risk of developing a DDI and is associated to a worse early graft function among uncolonized recipients.
关于肺供体支气管肺泡灌洗（BAL）阳性的危险因素、供体源性感染（DDI）的发生率以及BAL阳性对肺移植（LuTx）受者结局的影响，存在不一致的数据。
对2016年1月至2022年12月在单一中心进行的连续肺移植进行回顾性分析。在获取供体前收集其数据，包括特征、移植物功能和BAL样本。受者在肺移植前以及肺移植后约第3、7和14天接受BAL检查。DDI定义为供体和受者之间相同细菌种类的BAL阳性（细菌生长≥10菌落形成单位）。评估受者的术前特征、术中管理和术后结局。根据肺移植前的肺部定植状态确定两个受者队列。
在188例肺移植手术中，分析了169例。36%的供体BAL检测呈阳性。获取供体时的特征和移植物功能与BAL阳性无关。检测到14例DDI，占接受BAL阳性移植物的受者的23%。仅在未定植的受者中，接受BAL阳性的移植物与肺移植后72小时需要更高呼气末正压水平、更低的PaO/FiO、更长的机械通气时间和更长的重症监护病房住院时间进行有创通气的可能性更高相关。住院时间无差异。
接受BAL阳性的移植物，其难以通过供体特征预测，存在发生DDI的风险，并且与未定植受者中较差的早期移植物功能相关。
