Donor to Recipient Transmission of Bacterial Pathogens in Relation to Cold Ischemic Time in Lung Transplantation

Purpose

To evaluate the effect of cold ischemic time (CIT) on donor pathogen transmission after lung transplantation (LTx).

Methods

We reviewed data of 59 patients from 2011 to 2018 and analyzed the cultures results of donor bronchial aspirate (DBA), graft endobronchial bacterial swab (GEBS), recipient bacterial status before transplantation (RBT) and postoperative recipient bronchial aspirate (RBA) in relation to donor hospital length of stay (LOS), CIT and to recipient intubation time, Intensive Care Unit (ICU) and hospital LOS, perioperative and infection related deaths. The groups were compared using Mann-Withney U test and Fisher's exact test, death risk was analyzed as hazard ratio with 95% CI.

Results

Single LTx was in 17 cases, bilateral LTx in 42. First/only lung CIT1 was 403±107 min, second lung CIT2 - 541±114 min (the data are shown as mean ± Standard Deviation) . Cultures were positive in 42,2% DBA, 83,1% GEBS, 79,7% RTB, 33,9% RBA. Longer donor hospital LOS (132±52 v.100±79 hrs) was associated with isolation of DBA Gram-negative bacteria (n=16), especially A. baumannii). Longer CIT2 (600±109 v. 518±108 min) was related to Gram-positive bacteria other than MSSA in GEBS and it caused recipient's longer ICU LOS (21±18 v. 10±13 days). Longer CIT1 (476±113 v. 388±100 min) and CIT2 (613±91 v. 522±113 min) was associated with growing the new pathogens in RBA. Longer CIT1 (440±102 v. 374±102 min) and CIT2 (584±101 v. 498±111 min) caused prolonged recipient intubation time above 3 days (n=26) and CIT2 (607±93 v. 521±113 min) was related to recipient perioperative death (n=10), but these two factors were not affected by positive DBA, GEBS nor RBA.. Recipient infection deaths (n=4), recipient ICU LOS above 7 days (n=21) and hospital LOS above 30 days (n=30) were not related to DBA, GEBS nor RBA. Positive DBA, GEBS and RBA did not increase recipient death risk - HR 0,690; 0,348 and 1,369 respectively.

Conclusion

The cultures GEBS brought more information than DBA. Longer CIT increased Gram-positive bacteria load other than MSSA in GEBS. Donor hospital LOS was correlated with Gram-negative bacteria colonization. Positive cultures of DBA, GEBS, RBA did not affect recipient intubation time, ICU and hospital LOS, perioperative or infection related deaths.