Influence of the donor lung on development of early infections in lung transplant recipients

M. Zenati, Robert Dowling, J. S. Dummer, I. L. Paradis, V. C. Arena, J. M. Armitage, R. L. Kormos, R. L. Hardesty, B. P. Griffith

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Abstract

Infection of the lung allograft is the greatest cause of morbidity and mortality after heart-lung transplantation. To better understand the pathogenesis of these infections, we compared the results from cultures of the donor tracheas with the type and prevalence of early intrathoracic infections in the recipients. In the last 37 recipients, intrathoracic infections occurred within 2 weeks of operation in 16 (43%). Organisms isolated from the donor tracheal cultures were different from those associated with early infections, except for three of four recipients with heavy growth of Candida in donor tracheal cultures, in whom fatal invasive candidiasis developed caused by the same species of Candida isolated from the donor culture. Comparisons were made between recipients with (n = 16) and without early infection (n = 21) for age of donors and recipients, ischemic time, length of donor stay in an intensive care unit, donor arterial oxygen pressure, duration of recipient intubation, sterile donor tracheal culture or culture with presence of mouth flora, bacterial pathogens, or Candida, method of lung preservation, and antibiotic prophylaxis of donor. The only factor significantly associated with the onset of early infection was the presence of mouth flora in the donor tracheal culture (p = 0.004, Fisher's exact test, two sided). Multiple logistic regression was performed to test the additional contribution of other covariates after adjusting for the presence of mouth flora. None of the other covariates contributed to the occurrence of early infection. Recipients with early infection had a significantly lower survival compared with those without early infection (p = 0.04) by the Kaplan-Meier survival analysis. We conclude that mouth flora in the donor tracheal culture, probably a marker of undetected aspiration, leads to early infection and lower survival in the recipient. The presence of heavy growth of Candida in the donor tracheal culture is also associated with the occurrence of invasive candidiasis in the recipient.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalJournal of Heart Transplantation
Volume9
Issue number5
StatePublished - Jan 1 1990

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Tissue Donors
Lung
Infection
Candida
Mouth
Invasive Candidiasis
Transplant Recipients
Heart-Lung Transplantation
Antibiotic Prophylaxis
Kaplan-Meier Estimate
Survival Analysis
Growth
Trachea
Intubation
Allografts
Intensive Care Units
Length of Stay
Arterial Pressure
Logistic Models
Oxygen

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Zenati, M., Dowling, R., Dummer, J. S., Paradis, I. L., Arena, V. C., Armitage, J. M., ... Griffith, B. P. (1990). Influence of the donor lung on development of early infections in lung transplant recipients. Journal of Heart Transplantation, 9(5), 502-509.
Zenati, M. ; Dowling, Robert ; Dummer, J. S. ; Paradis, I. L. ; Arena, V. C. ; Armitage, J. M. ; Kormos, R. L. ; Hardesty, R. L. ; Griffith, B. P. / Influence of the donor lung on development of early infections in lung transplant recipients. In: Journal of Heart Transplantation. 1990 ; Vol. 9, No. 5. pp. 502-509.
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Zenati, M, Dowling, R, Dummer, JS, Paradis, IL, Arena, VC, Armitage, JM, Kormos, RL, Hardesty, RL & Griffith, BP 1990, 'Influence of the donor lung on development of early infections in lung transplant recipients', Journal of Heart Transplantation, vol. 9, no. 5, pp. 502-509.

Influence of the donor lung on development of early infections in lung transplant recipients. / Zenati, M.; Dowling, Robert; Dummer, J. S.; Paradis, I. L.; Arena, V. C.; Armitage, J. M.; Kormos, R. L.; Hardesty, R. L.; Griffith, B. P.

In: Journal of Heart Transplantation, Vol. 9, No. 5, 01.01.1990, p. 502-509.

Research output: Contribution to journalArticle

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T1 - Influence of the donor lung on development of early infections in lung transplant recipients

AU - Zenati, M.

AU - Dowling, Robert

AU - Dummer, J. S.

AU - Paradis, I. L.

AU - Arena, V. C.

AU - Armitage, J. M.

AU - Kormos, R. L.

AU - Hardesty, R. L.

AU - Griffith, B. P.

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N2 - Infection of the lung allograft is the greatest cause of morbidity and mortality after heart-lung transplantation. To better understand the pathogenesis of these infections, we compared the results from cultures of the donor tracheas with the type and prevalence of early intrathoracic infections in the recipients. In the last 37 recipients, intrathoracic infections occurred within 2 weeks of operation in 16 (43%). Organisms isolated from the donor tracheal cultures were different from those associated with early infections, except for three of four recipients with heavy growth of Candida in donor tracheal cultures, in whom fatal invasive candidiasis developed caused by the same species of Candida isolated from the donor culture. Comparisons were made between recipients with (n = 16) and without early infection (n = 21) for age of donors and recipients, ischemic time, length of donor stay in an intensive care unit, donor arterial oxygen pressure, duration of recipient intubation, sterile donor tracheal culture or culture with presence of mouth flora, bacterial pathogens, or Candida, method of lung preservation, and antibiotic prophylaxis of donor. The only factor significantly associated with the onset of early infection was the presence of mouth flora in the donor tracheal culture (p = 0.004, Fisher's exact test, two sided). Multiple logistic regression was performed to test the additional contribution of other covariates after adjusting for the presence of mouth flora. None of the other covariates contributed to the occurrence of early infection. Recipients with early infection had a significantly lower survival compared with those without early infection (p = 0.04) by the Kaplan-Meier survival analysis. We conclude that mouth flora in the donor tracheal culture, probably a marker of undetected aspiration, leads to early infection and lower survival in the recipient. The presence of heavy growth of Candida in the donor tracheal culture is also associated with the occurrence of invasive candidiasis in the recipient.

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Zenati M, Dowling R, Dummer JS, Paradis IL, Arena VC, Armitage JM et al. Influence of the donor lung on development of early infections in lung transplant recipients. Journal of Heart Transplantation. 1990 Jan 1;9(5):502-509.