1. Lung donor bronchoalveolar lavage positivity: Incidence, risk factors, and lung transplant recipients' outcome.
- Author
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Fumagalli J, Punzi V, Scaravilli V, Passamonti SM, Morlacchi LC, Rossetti V, Maraschini A, Matinato C, Brivio M, Righi I, Blasi F, Bandera A, Rosso L, Panigada M, Zanella A, and Grasselli G
- Subjects
- Humans, Male, Retrospective Studies, Female, Risk Factors, Incidence, Adult, Middle Aged, Bronchoalveolar Lavage methods, Transplant Recipients, Lung Transplantation, Tissue Donors, Bronchoalveolar Lavage Fluid microbiology
- Abstract
Background: 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., Methods: 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
4 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., Results: 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 PaO2 /FiO2 , prolonged duration of mechanical ventilation and longer ICU stay. No difference in hospital length of stay was observed., Conclusions: 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., Competing Interests: Conflicts of interest The authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter discussed in this manuscript., (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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