Interleucina-8 en el lavado broncoalveolar del donante y su impacto en la disfunción primaria del injerto en el trasplante bipulmonar

Abstract

Background and Objective The purpose of this study was to determine concentrations of interleukin 8 (IL-8) in the bronchoalveolar lavage (BAL) fluid from donor lungs and assess the role of IL-8 levels in the development of primary graft failure. Patients and Method Twenty patients who received a double lung transplant were studied. A series of data, including BAL fluid concentrations of IL-8, were collected for the donors. Data collected for the recipients included arterial blood gases after 6, 24, and 48 hours, and intubation time. Patients with a ratio of PaO 2 to the fraction of inspired oxygen (FiO 2) of less than 300 during the first 48 hours were diagnosed with primary graft failure. IL-8 levels were determined by enzyme-linked immunosorbent assay. Associations between the donor variables and IL-8 concentrations were evaluated using the Spearman rank correlation coefficient (ρ) and the Mann-Whitney test for categorical and continuous variables, respectively. Logistic regression was used for multivariate analysis. Results Fifteen of the 20 donors were men. The cause of brain death was trauma in 9 donors, 7 were smokers, 13 required inotropic support, and pathogens were isolated in the BAL fluid of 18. The median age was 35 years (interquartile range [IQR], 23.5–51.25 y), the median ventilation time was 1 day (IQR, 1–2 d), the median PaO 2/FiO 2 was 459.5 (IQR, 427–510.25), and the median IL-8 concentration in BAL fluid was 49.01 ng/L (IQR, 7.86–94.05 ng/mL). Ten of the recipients were men and the median age was 48.43 years (IQR, 25.4–56.81 y). The median ischemic time was 210 minutes (IQR, 176.25–228.75 min) for the first lung and 300 minutes (IQR, 273.75–333.73 min) for the second lung. The median PaO 2/FiO 2 ratio for the implant at 6, 14, and 48 hours was 329 (IQR, 190.25–435), 363.5 (IQR, 249–434.75), and 370.5 (IQR, 243.25–418.25), respectively. The median intubation time was 39.5 hours (IQR, 19.25–68.5 h) and the correlation with IL-8 values was positive: higher IL-8 concentrations in BAL fluid correlated with longer ventilation times (Spearman rank correlation, P=.007; ρ=0.583). Five patients developed primary graft failure; IL-8 concentrations were significantly higher in these patients than in those whose grafts did not fail (Mann-Whitney test, P=.003). Conclusion High IL-8 concentrations in donor BAL fluid lead to longer ventilation time in the recipients and favor the development of primary graft failure after lung transplant.