The effect of ex vivo lung perfusion on microbial load in human donor lungs

Andreasson, Anders, Karamanou, Danai, Perry, John, Perry, Audrey, Ӧzalp, Faruk, Butt, Tanveer, Morley, Katie, Walden, Hannah, Clark, Stephen, Prabhu, Mahesh, Corris, Paul, Gould, Kate, Fisher, Andrew and Dark, John (2014) The effect of ex vivo lung perfusion on microbial load in human donor lungs. The Journal of Heart and Lung Transplantation, 33 (9). pp. 910-916. ISSN 1053-2498

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Official URL: http://dx.doi.org/10.1016/j.healun.2013.12.023

Abstract

Background

Ex vivo lung perfusion (EVLP) has emerged as a technique to potentially recondition unusable donor lungs for transplantation. Beneficial effects of EVLP on physiologic function have been reported, but little is known about the effect of normothermic perfusion on the infectious burden of the donor lung. In this study, we investigated the effect of EVLP on the microbial load of human donor lungs.

Methods

Lungs from 18 human donors considered unusable for transplantation underwent EVLP with a perfusate containing high-dose, empirical, broad-spectrum anti-microbial agents. Quantitative cultures of bacteria and fungi were performed on bronchoalveolar lavage fluid from the donor lung before and after 3 to 6 hours of perfusion. The identification of any organisms and changes in number of colony forming units before and after EVLP were assessed and anti-microbial susceptibilities identified.

Results

Thirteen out of 18 lungs had positive cultures, with bacterial loads significantly decreasing after EVLP. Yeast loads increased when no anti-fungal treatment was given, but were reduced when prophylactic anti-fungal treatment was added to the circuit. Six lungs were ultimately transplanted into patients, all of whom survived to hospital discharge. There was 1 death at 11 months.

Conclusions

Our study shows that EVLP with high-dose, empirical anti-microbial agents in the perfusate is associated with an effective reduction in the microbial burden of the donor lung, a benefit that has not previously been demonstrated.

Item Type: Article
Uncontrolled Keywords: lung transplantation, ex vivo lung perfusion, antibiotics, fungicides, donor lung, microbiology
Subjects: B100 Anatomy, Physiology and Pathology
C500 Microbiology
Department: Faculties > Health and Life Sciences > School of Life Sciences > Applied Sciences
Depositing User: Paul Burns
Date Deposited: 28 Aug 2014 10:27
Last Modified: 03 Nov 2016 12:25
URI: http://nrl.northumbria.ac.uk/id/eprint/17500

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