Abstract
BackgroundNormally functioning airway cilia is essential for efficient mucociliary clearance to protect the airway from various insults. Impaired clearance may lead to increased risk of infections and progressive lung damage. Significant morbidity in the immediate post lung transplantation period is associated with airway infection, which we hypothesize may be caused by impaired cilia function.MethodsAirway cilia beating pattern (CBP) and frequency (CBF) were studied on brushing samples taken from above and below the transplant anastomosis of adult lung transplant recipients (n = 20) during routine bronchoscopies at 6, 12, and 26 weeks posttransplant. Bronchoaveolar Lavage (BAL) samples were also collected at each time points.ResultsAt 6 weeks posttransplant (n = 16), CBP from the donated lung showed reduced beating amplitude with the overall CBF 2.28 Hz slower than the patients' native upper airway cilia (median ± SIQR: 5.36 ± 0.93 Hz vs. 7.64 ± 0.92 Hz, p value < .001). At 12 weeks (n = 16), donor lungs CBP showed recovery with the difference in CBF reduced to 0.74 Hz (6.36 ± 1.46 Hz vs. 7.10 ± 0.86 Hz, p value < .05). Impaired cilia function was not associated with positive BAL cultures.ConclusionReduced cilia function is evident in the first 12 weeks post lung transplant, with both CBP and CBF returning to levels of function indistinguishable to the patients' upper airway cilia beyond this time.
Highlights
Lung transplantation is an accepted treatment for various end‐stage lung diseases, with overall survival outcomes improving over the past decade
There was a weak negative correlation (R = −0.4957, p value < .05) between the length of intubation time required in intensive care unit (ICU) and donor lungs' cilia beat frequency analysis (CBF) assessed at 6‐week bronchoscopy procedure (Figure 2), with patients requiring shorter intubation times showing moderately faster cilia beating in their donor lungs
This present study has described a period of impaired airway cilia function and by extension mucociliary clearance (MCC) in the immediate post lung transplant period that in most case is not fully resolved until 12 weeks posttransplant
Summary
Lung transplantation is an accepted treatment for various end‐stage lung diseases, with overall survival outcomes improving over the past decade. MCC in the donated lungs has been shown to be impaired following transplantation, with up to 50% loss in clearance observed in some cases.[7,8] The exact etiology for impaired MCC following lung transplant remains unclear, and early investigations into airway cilia beat frequency analysis (CBF) have yielded contradictory findings.[9,10,11,12] In a 2012 cross‐sectional study, Thomas et al.[11] demonstrated comparable cilia beat pattern (CBP) between native cilia and donor lungs in children receiving lung transplantation at random time points between 7 and 12 months posttransplant.[11] Analysis of CBP in donated lungs following transplantation in adult recipients has not been explored previously. Two‐tailed Spearman's correlation analysis was used to demonstrate the relationship between organ ischemic time or postoperative ventilation time and donor lungs' CBF at 6 weeks posttransplant. p values less than .05 indicated a statistically significant difference between comparisons
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