Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia

Research output: Contribution to journalArticle

Abstract

Background: Optimal management of early airway infection is essential for the survival of lung transplant (LTx) recipients during the first 12 months after transplantation. This study aimed to explore the main cause of post-lung transplant pneumonia (PLTP) within 30 days after LTx. Methods: Forty LTx patients were retrospectively analyzed. Sputum sampling from donors’ and recipients’ airways was performed pretransplant and posttransplant daily for the first 30 days after LTx. Organisms in the recipient’s and donor’s original airways were compared to pathogens responsible for PLTP. Patients with and without PLTP were also compared to identify relevant risk factors. Results: Seventeen (42.5%) patients developed pneumonia (PLTP group) and 23 had no episode of pneumonia (Non-PLTP group) during the first 30 days. In the PLTP group, median time from LTx to PLTP onset was 6 days. A significantly higher incidence of PLTP was caused by recipient’s rather than donor’s original airway bacteria (62% vs 13%, p < 0.01). Smoking history of the donor and pretransplant airway bacterial colonization of the recipient were independent risk factors of PLTP which was associated with prolonged posttransplant mechanical ventilation with longer intensive care unit stay and worse survival outcomes. Conclusions: The recipient’s original airway microflora rather than the donor’s, was highly associated with PLTP. A combination of donor smoking history and recipient airway infection should be avoided, while evidence of donor lung infection is not a contraindication for LTx.

Original languageEnglish
JournalGeneral Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Pneumonia
Tissue Donors
Bacteria
Transplants
Lung
Infection
Smoking
Airway Management
Sputum
Artificial Respiration
Intensive Care Units
Transplantation
History
Survival
Incidence

Keywords

  • Airway colonization
  • Lung transplantation
  • Posttransplant pneumonia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{0f54f2e60b2d4f8a93db78e7580548f8,
title = "Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia",
abstract = "Background: Optimal management of early airway infection is essential for the survival of lung transplant (LTx) recipients during the first 12 months after transplantation. This study aimed to explore the main cause of post-lung transplant pneumonia (PLTP) within 30 days after LTx. Methods: Forty LTx patients were retrospectively analyzed. Sputum sampling from donors’ and recipients’ airways was performed pretransplant and posttransplant daily for the first 30 days after LTx. Organisms in the recipient’s and donor’s original airways were compared to pathogens responsible for PLTP. Patients with and without PLTP were also compared to identify relevant risk factors. Results: Seventeen (42.5{\%}) patients developed pneumonia (PLTP group) and 23 had no episode of pneumonia (Non-PLTP group) during the first 30 days. In the PLTP group, median time from LTx to PLTP onset was 6 days. A significantly higher incidence of PLTP was caused by recipient’s rather than donor’s original airway bacteria (62{\%} vs 13{\%}, p < 0.01). Smoking history of the donor and pretransplant airway bacterial colonization of the recipient were independent risk factors of PLTP which was associated with prolonged posttransplant mechanical ventilation with longer intensive care unit stay and worse survival outcomes. Conclusions: The recipient’s original airway microflora rather than the donor’s, was highly associated with PLTP. A combination of donor smoking history and recipient airway infection should be avoided, while evidence of donor lung infection is not a contraindication for LTx.",
keywords = "Airway colonization, Lung transplantation, Posttransplant pneumonia",
author = "Yusuke Konishi and Kentaroh Miyoshi and Takeshi Kurosaki and Shinji Otani and Seiichiro Sugimoto and Masaomi Yamane and Takahiro Oto and Shinichi Toyooka",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11748-019-01273-6",
language = "English",
journal = "General Thoracic and Cardiovascular Surgery",
issn = "1863-6705",
publisher = "Springer Japan",

}

TY - JOUR

T1 - Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia

AU - Konishi, Yusuke

AU - Miyoshi, Kentaroh

AU - Kurosaki, Takeshi

AU - Otani, Shinji

AU - Sugimoto, Seiichiro

AU - Yamane, Masaomi

AU - Oto, Takahiro

AU - Toyooka, Shinichi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Optimal management of early airway infection is essential for the survival of lung transplant (LTx) recipients during the first 12 months after transplantation. This study aimed to explore the main cause of post-lung transplant pneumonia (PLTP) within 30 days after LTx. Methods: Forty LTx patients were retrospectively analyzed. Sputum sampling from donors’ and recipients’ airways was performed pretransplant and posttransplant daily for the first 30 days after LTx. Organisms in the recipient’s and donor’s original airways were compared to pathogens responsible for PLTP. Patients with and without PLTP were also compared to identify relevant risk factors. Results: Seventeen (42.5%) patients developed pneumonia (PLTP group) and 23 had no episode of pneumonia (Non-PLTP group) during the first 30 days. In the PLTP group, median time from LTx to PLTP onset was 6 days. A significantly higher incidence of PLTP was caused by recipient’s rather than donor’s original airway bacteria (62% vs 13%, p < 0.01). Smoking history of the donor and pretransplant airway bacterial colonization of the recipient were independent risk factors of PLTP which was associated with prolonged posttransplant mechanical ventilation with longer intensive care unit stay and worse survival outcomes. Conclusions: The recipient’s original airway microflora rather than the donor’s, was highly associated with PLTP. A combination of donor smoking history and recipient airway infection should be avoided, while evidence of donor lung infection is not a contraindication for LTx.

AB - Background: Optimal management of early airway infection is essential for the survival of lung transplant (LTx) recipients during the first 12 months after transplantation. This study aimed to explore the main cause of post-lung transplant pneumonia (PLTP) within 30 days after LTx. Methods: Forty LTx patients were retrospectively analyzed. Sputum sampling from donors’ and recipients’ airways was performed pretransplant and posttransplant daily for the first 30 days after LTx. Organisms in the recipient’s and donor’s original airways were compared to pathogens responsible for PLTP. Patients with and without PLTP were also compared to identify relevant risk factors. Results: Seventeen (42.5%) patients developed pneumonia (PLTP group) and 23 had no episode of pneumonia (Non-PLTP group) during the first 30 days. In the PLTP group, median time from LTx to PLTP onset was 6 days. A significantly higher incidence of PLTP was caused by recipient’s rather than donor’s original airway bacteria (62% vs 13%, p < 0.01). Smoking history of the donor and pretransplant airway bacterial colonization of the recipient were independent risk factors of PLTP which was associated with prolonged posttransplant mechanical ventilation with longer intensive care unit stay and worse survival outcomes. Conclusions: The recipient’s original airway microflora rather than the donor’s, was highly associated with PLTP. A combination of donor smoking history and recipient airway infection should be avoided, while evidence of donor lung infection is not a contraindication for LTx.

KW - Airway colonization

KW - Lung transplantation

KW - Posttransplant pneumonia

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SN - 1863-6705

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