THE DONOR LUNG - INFECTIOUS AND PATHOLOGICAL FACTORS AFFECTING OUTCOME IN LUNG TRANSPLANTATION

The prevalence of posttransplantation pulmonary infection and the impo rtance of this complication with respect to morbidity in patients unde rgoing lung transplantation is significant. Over a 1-year period, case histories of all patients undergoing lung transplantation at Barnes H ospital Washington University, were reviewed to examine the importance of organisms isolated in the donor lung in the development of subsequ ent invasive infection in transplant recipients. Twenty-eight of 29 br onchial washings (97 %) taken from donors before retrieval grew at lea st one organism. ne most common organisms identified were Staphylococc us and Enterobacter. In 12 of these cases (43 %), similar organisms we re isolated from the tracheobronchial tree of the recipients, and 6 of these recipients (21 %) subsequently had invasive pulmonary infection s as a result of the organism originally isolated in the donor. We rec ommend that antibiotic coverage in transplant recipients should be ini tiated on the basis of Gram stain results and modified on the basis of cultures obtained from the donor lungs. Pathologic analysis of donor lung tissue taken before transplantation was available in 12 cases. Fo ur donors had histologic evidence of established pneumonia in the dono r lung, and infections then developed in the recipients. One other pat ient who received a lung that had widespread bone marrow emboli and su bsequent infarction later had a complete anastomotic dehiscence. An ad ditional patient had profound early donor lung dysfunction without any evidence of rejection or infection. Pathologic findings from the dono r in this case demonstrated preexistent acute vasculitis with emboli. We suggest that as preservation techniques improve, the opportunities for closer scrutiny of donor lung tissue before implantation will beco me increasing desirable and feasible.