Influences of Perioperative Airway Pathogens on the Clinical Course in Living and Cadaveric Lung Transplantation

Abstract

Purpose To evaluate the effects of pathogenic bacteria (PB) in the respiratory tract, we investigated perioperative airway pathogens of recipients and donors in living-donor lobar lung transplantation (LDLLT) and cadaveric lung transplantation (CLT). Methods Between Jun. 2008 and Sep. 2018, 193 lung transplants (LTxs) were performed at our institution. There were 85 LDLLTs involving 156 living donors, while there were 108 CLTs involving 104 brain-dead donors. We investigated PB in the respiratory tract of the recipients before LTx and within 1 month after LTx. Furthermore, we also investigated PB in the respiratory tract of the donors before LTx. Results In LDLLT, PB were found in 19 recipients (22.4%) before LTx, while PB were found only in 3 living donors (1.9%). In CLT, PB were found in 28 recipients (25.9%) before LTx and PB were found in 71 cadaveric donors (65.7%). There were no recipients who died of the infectious disease caused by PB derived from donors. The existence of PB both in recipient and donor (R+/D+) showed the worst survival, but there was no significant difference in comparison with other groups (R+/D-, R-/D+, R-/D-, Fig. 1). Of note, quite a few PB, which were derived neither from recipients nor donors, was detected in the recipient's airway within 1 month after LTx. PB was found from sputum culture in 45 recipients (52.9%) in LDLLT and in 50 recipients (46.2%) in CLT, respectively. However, no recipients died of infection caused by newly detected PB after LTx. On the other hand, patients whose PB was not found postoperatively had a better 5-year survival compared to patients whose PB were found (76.2% vs. 63.9%, p=0.031: Fig. 2). Conclusion Graft lungs of living donors were significantly cleaner than those of cadaveric donors microbiologically. Regardless of LDLLT or CLT, respiratory tract of the recipients were exposed to a variety of PB derived from neither donors nor recipients. Although PB were not the cause of death in early time after TLx, PB may influence long-term clinical course.