Outcome After Lung Transplantation From a Donor With Bacterial Pneumonia Under the Japanese Donor Evaluation System |
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| Affiliation: | 1. Department of Thoracic Surgery, Kyoto University Hospital, Sakyo Ward, Kyoto, Japan;2. Department of Infection Control and Prevention, Kyoto University Hospital, Sakyo Ward, Kyoto, Japan;1. Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil;2. Laboratory of Medical Investigation 37 (LIM-37), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil;3. Kidney Transplantation Division, Department of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil;1. Division of Transplant Surgery, Department of Surgery;2. Division of Nephrology, Department of Medicine, Center for Liver Investigation Fostering Discovery (C-LIFE), Department of Medicine, University of Washington, Seattle;3. Division of Gastroenterology and Hepatology, Center for Liver Investigation Fostering Discovery (C-LIFE), Department of Medicine, University of Washington, Seattle;1. Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. Huadong Hospital Affiliated to Fudan University, Shanghai, Shanghai, China;1. Kidney Center, University of Turku and Turku University Hospital, Finland;2. Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;3. Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;4. Department of Anaesthesiology and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland;5. Perioperative Services, Intensive Care and Pain Medicine, University of Turku and Turku University Hospital, Turku, Finland;1. Division of Hematology & HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia;2. King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia;3. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia;4. Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia;1. Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá D.C Colombia;2. Cardiology Unit - Heart Failure and Heart Transplant Clinic, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá D.C Colombia |
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| Abstract: | ![]()
BackgroundIn Japan, a unique medical consultant system for donor evaluation and management has been developed in an effort to maximize the use of extended criteria donor lungs. The aim of this study was to investigate the impact of donor pneumonia (DP) on the outcome after lung transplantation under this system.Materials and MethodsClinical data of 85 patients who underwent deceased donor lung transplantation (41 single and 44 bilateral lung transplants) between August 2012 and March 2018 were reviewed. DP was defined as the recognition of pneumonia on imaging with positive bacterial culture in the airway at the time of transplantation.ResultsTwenty-three transplanted lung grafts were recognized as having DP (27.1%). Serial chest x-rays at the donor hospital did not show deteriorating infiltration or consolidation. The PaO2/FiO2 ratio at brain death evaluations were similar between the donor pneumonia (DP) negative (-) and donor pneumonia (DP) positive (+) groups. Perioperative antibiotics were effective against 94% of isolated bacteria. The duration of postoperative antibiotics therapy was longer in the DP (+) group (P = .02). The incidence of primary graft dysfunction and acute rejection, intensive care unit stay, chronic lung allograft dysfunction–free survival, and overall survival were similar between the DP (+) and DP (?) groups.ConclusionsTransplantation of donor lung grafts harboring pneumonia but having a similar oxygenation level to those without pneumonia was safely performed and did not affect long-term outcome. Appropriate evaluation of serial imaging at donor hospital and suitable perioperative antibiotic management may be reasons for this outcome. |
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