Prognostic impact of preoperative respiratory colonization on early-onset pneumonia after lung transplantation

Taehwa Kim; Hye Ju Yeo; Jin Ho Jang; Dohyung Kim; Doosoo Jeon; Yun Seong Kim; Woo Hyun Cho

doi:10.21037/jtd-21-1724

Prognostic impact of preoperative respiratory colonization on early-onset pneumonia after lung transplantation

J Thorac Dis. 2022 Jun;14(6):1900-1908. doi: 10.21037/jtd-21-1724.

Authors

Taehwa Kim¹, Hye Ju Yeo¹, Jin Ho Jang¹, Dohyung Kim^{2

3}, Doosoo Jeon^{1

3}, Yun Seong Kim^{1

3}, Woo Hyun Cho^{1

3}

Affiliations

¹ Division of Pulmonology, Allergy and Critical Care Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
² Department of Cardiovascular and Thoracic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
³ Department of Internal Medicine, School of Medicine, Pusan National University, Pusan, Korea.

Abstract

Background: The number of lung transplantation procedures is rapidly increasing worldwide. Little is known about the effect of perioperative respiratory microbial colonization on pneumonia during lung transplantation. We evaluated the microbiome composition and incidence of early pneumonia in patients undergoing lung transplantation. We investigated factors related to post-transplant pneumonia (PTP) after lung transplantation.

Methods: A retrospective analysis of patients subjected to lung transplantation between May 2013 and December 2019 was performed. Perioperative microbial colonization, and its relationship with early pneumonia, were examined in specimens from bronchial washing, bronchoalveolar lavage, and sputum aspiration before and after surgery. One-year mortality, as the primary outcome, was analyzed using the Kaplan-Meier curve model.

Results: Among 76 patients who underwent lung transplantation, 34 donors (44.7%) and 28 recipients (36.8%) showed positive respiratory cultures with respect to preoperative respiratory colonization. A separate analysis of donors and recipients showed that 42 donors and 48 recipients were in respiratory non-colonized state, and 28 (53.8%) donors and 36 (69.2%) recipients survived 1 year after lung transplantation. Acinectobacter baumannii was the most common respiratory multidrug-resistant (MDR) pathogen. PTP was significantly lower in the survivor group (38.5% vs. 70.8%, P=0.009). Out of the recipients with preoperative respiratory colonization, 57.1% survived 1 year after lung transplantation. Patients with PTP had significantly higher 1-year mortality than those without PTP (P=0.009). Preoperative respiratory colonization of the recipients (P=0.010) and PTP patients (P=0.005) was associated with high 1-year mortality rate. Perioperative respiratory colonization of donors was not associated with the incidence of PTP and 1-year survival.

Conclusions: Perioperative colonization of recipients was a powerful predictive factor for PTP, which was associated with 1-year mortality in patients subjected to lung transplantation. Our results suggest that donor acceptance criteria may change to better address potential shortages in organ donation.

Keywords: Pneumonia; colonization; lung transplantation; multidrug-resistant (MDR) bacteria.