TY - JOUR
T1 - The effect of ex vivo lung perfusion on microbial load in human donor lungs
AU - Andreasson, Anders
AU - Karamanou, Danai
AU - Perry, John
AU - Perry, Audrey
AU - Ӧzalp, Faruk
AU - Butt, Tanveer
AU - Morley, Katie
AU - Walden, Hannah
AU - Clark, Stephen
AU - Prabhu, Mahesh
AU - Corris, Paul
AU - Gould, Kate
AU - Fisher, Andrew
AU - Dark, John
PY - 2014/1/13
Y1 - 2014/1/13
N2 - Background
Ex vivo lung perfusion (EVLP) has emerged as a technique to potentially recondition unusable donor lungs for transplantation. Beneficial effects of EVLP on physiologic function have been reported, but little is known about the effect of normothermic perfusion on the infectious burden of the donor lung. In this study, we investigated the effect of EVLP on the microbial load of human donor lungs.
Methods
Lungs from 18 human donors considered unusable for transplantation underwent EVLP with a perfusate containing high-dose, empirical, broad-spectrum anti-microbial agents. Quantitative cultures of bacteria and fungi were performed on bronchoalveolar lavage fluid from the donor lung before and after 3 to 6 hours of perfusion. The identification of any organisms and changes in number of colony forming units before and after EVLP were assessed and anti-microbial susceptibilities identified.
Results
Thirteen out of 18 lungs had positive cultures, with bacterial loads significantly decreasing after EVLP. Yeast loads increased when no anti-fungal treatment was given, but were reduced when prophylactic anti-fungal treatment was added to the circuit. Six lungs were ultimately transplanted into patients, all of whom survived to hospital discharge. There was 1 death at 11 months.
Conclusions
Our study shows that EVLP with high-dose, empirical anti-microbial agents in the perfusate is associated with an effective reduction in the microbial burden of the donor lung, a benefit that has not previously been demonstrated.
AB - Background
Ex vivo lung perfusion (EVLP) has emerged as a technique to potentially recondition unusable donor lungs for transplantation. Beneficial effects of EVLP on physiologic function have been reported, but little is known about the effect of normothermic perfusion on the infectious burden of the donor lung. In this study, we investigated the effect of EVLP on the microbial load of human donor lungs.
Methods
Lungs from 18 human donors considered unusable for transplantation underwent EVLP with a perfusate containing high-dose, empirical, broad-spectrum anti-microbial agents. Quantitative cultures of bacteria and fungi were performed on bronchoalveolar lavage fluid from the donor lung before and after 3 to 6 hours of perfusion. The identification of any organisms and changes in number of colony forming units before and after EVLP were assessed and anti-microbial susceptibilities identified.
Results
Thirteen out of 18 lungs had positive cultures, with bacterial loads significantly decreasing after EVLP. Yeast loads increased when no anti-fungal treatment was given, but were reduced when prophylactic anti-fungal treatment was added to the circuit. Six lungs were ultimately transplanted into patients, all of whom survived to hospital discharge. There was 1 death at 11 months.
Conclusions
Our study shows that EVLP with high-dose, empirical anti-microbial agents in the perfusate is associated with an effective reduction in the microbial burden of the donor lung, a benefit that has not previously been demonstrated.
KW - lung transplantation
KW - ex vivo lung perfusion
KW - antibiotics
KW - fungicides
KW - donor lung
KW - microbiology
U2 - 10.1016/j.healun.2013.12.023
DO - 10.1016/j.healun.2013.12.023
M3 - Article
SN - 1053-2498
SN - 1557-3117
VL - 33
SP - 910
EP - 916
JO - The Journal of Heart and Lung Transplantation
JF - The Journal of Heart and Lung Transplantation
IS - 9
ER -