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

Andreasson A1, Karamanou DM2, Perry JD3, Perry A4, Ӧzalp F4, Butt T4, Morley KE4, Walden HR5, Clark SC1, Prabhu M4, Corris PA1, Gould K4, Fisher AJ6, Dark JH1. ( Freeman Hospital, Newcastle:

J Heart Lung Transplant. 2014 Sep;33(9):910-6. doi: 10.1016/j.healun.2013.12.023. Epub 2014 Jan 9.    

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.

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.

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.

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.

Copyright © 2014 Internat. Soc.Heart & Lung Transplant.. Published by Elsevier Inc. All rights reserved.
KEYWORDS: antibiotics; donor lung; ex vivo lung perfusion; fungicides; lung transplantation; microbiology.        
PMID: 24631044. DOI: 10.1016/j.healun.2013.12.023