Infection from Lung Allograft Donors in Lung Transplantation

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IntroductionInfection was the leading cause of perioperative death after lung transplantation. Some infections were due to donor-to-host transmission. The Objective of these study was to evaluate the incidence and etiology of bacterial and fungal infection in lung allograft donors and to assess donor-to-host transmission of these infections.MethodFrom March 3, 2017 to December 4, 2017, we has performed 47 lung transplants in our lung transplantation center of China-Japan Friendship Hospital(CJFH). The incidence and etiology of bacterial and fungal infection in lung allograft donors were evaluated. All donor lungs were procured from donation after brain death and cardiac death.ResultsThere were 40 male recipients and 7 female recipients, age between 27-71 years old, median age was 62 years. Native lung disease included interstitial lung disease(32/47, 68.1%), obstructive lung disease(9/47, 19.1%), pulmonary hypertension(2/47, 0.4%) and bronchiectasis(4/47, 0.8%). Bilateral lung transplantations were 18(38.3%) and single lung transplantations were 29(61.7%).The overall incidence of donor infection was 63.8% (30 out of 47 donor lungs), including 30 bacterial infections and 4 fungal infections. The most common bacterial pathogen was Pseudomonas aeruginosa (9/30, 30%) and Acinetobacter Bauman (5/30, 20%). Donor-to-host transmission of bacterial or fungal infection occurred in 10 lung allograft recipients, 33%(10/30) of lung transplants performed. The pathogens included 4 Carbapenem resistant Pseudomonas aeruginosa (CRPA), including 1 pan- pan-drug-resistant Pseudomonas aeruginosa, the recipient survived 6 months after lung transplantation. Other pathogens included 3 Carbapenem resistant Acinetobacter Bauman (CRAB), 1 Klebsiella pneumoniae, 1 Burkholderia multivoran and 1 Aspergillus fumigatus. Of these cases, only one recipient died of CRAB infection.ConclusionDonor-to-host transmission of infection is a frequent event after lung transplantation. Pseudomonas aeruginosa was the most common bacterial pathogen. Appropriate prophylactic antibiotic regimen could avoid fatal consequences.

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