Abstract
<h3>Purpose</h3> Lung transplant recipients are at elevated risk of aspiration and subsequent microbial colonization and infection of the lungs, which portend worse clinical outcomes. Although aspiration is thought to affect the right lung more commonly than the left lung due to anatomical factors, such association has not been shown in lung transplant recipients. We hypothesized that bronchoalveolar lavage (BAL) from right single lung transplants (SLT) have higher microbiological culture positivity compared to BAL from left SLT, leading to worse outcomes in right SLT recipients. <h3>Methods</h3> All first adult SLT performed at our institution up to June 2021 with at least one BAL microbiological culture result were included. All BAL from surveillance and clinically indicated bronchoscopies were included. By our protocol, BAL is obtained from the transplanted lung, either the right middle lobe or lingula, unless clinically indicated otherwise. Fisher's exact test and univariable Cox proportional hazards model were used to compare culture positivity and outcomes, respectively. <h3>Results</h3> 165 right SLT recipients with 1505 cultures and 164 left SLT recipients with 1450 cultures were included. Baseline patient characteristics were comparable. BAL from right SLT had 17% positivity for significant respiratory pathogens, compared to 12% from left SLT (p<0.0001). Right SLT had higher positivity for <i>P. aeruginosa</i> (7% right vs. 4% left, p<0.001) and <i>S. aureus</i> (2% right vs. 1% left, p=0.04). There was similar positivity for high commensal flora (34% right vs. 36% left, p=0.26). There was a trend towards lower risk of chronic lung allograft dysfunction (HR 0.77 [0.55-1.09], p=0.1) and death/retransplant (HR 0.76 [0.58-1.01], p=0.06) in right SLT recipients. <h3>Conclusion</h3> BAL from right SLT have higher BAL microbiological culture positivity for significant respiratory pathogens, <i>P. aeruginosa</i>, and <i>S. aureus</i> compared to BAL from left SLT, with no difference in outcomes between right and left SLT recipients.
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