Background and objective: The purpose of this study was to determine concentrations of interleukin 8 (IL-8) in the bronchoalveolar lavage (BAL) fluid from donor lungs and assess the role of IL-8 levels in the development of primary graft failure.
Patients and method: Twenty patients who received a double lung transplant were studied. A series of data, including BAL fluid concentrations of IL-8, were collected for the donors. Data collected for the recipients included arterial blood gases after 6, 24, and 48 hours, and intubation time. Patients with a ratio of PaO(2) to the fraction of inspired oxygen (FiO(2)) of less than 300 during the first 48 hours were diagnosed with primary graft failure. IL-8 levels were determined by enzyme-linked immunosorbent assay. Associations between the donor variables and IL-8 concentrations were evaluated using the Spearman rank correlation coefficient (rho) and the Mann-Whitney test for categorical and continuous variables, respectively. Logistic regression was used for multivariate analysis.
Results: Fifteen of the 20 donors were men. The cause of brain death was trauma in 9 donors, 7 were smokers, 13 required inotropic support, and pathogens were isolated in the BAL fluid of 18. The median age was 35 years (interquartile range [IQR], 23.5-51.25y), the median ventilation time was 1 day (IQR, 1-2d), the median PaO(2)/FiO(2) was 459.5 (IQR, 427-510.25), and the median IL-8 concentration in BAL fluid was 49.01ng/L (IQR, 7.86-94.05ng/mL). Ten of the recipients were men and the median age was 48.43 years (IQR, 25.4-56.81y). The median ischemic time was 210 minutes (IQR, 176.25-228.75 min) for the first lung and 300 minutes (IQR, 273.75-333.73 min) for the second lung. The median PaO(2)/FiO(2) ratio for the implant at 6, 14, and 48 hours was 329 (IQR, 190.25-435), 363.5 (IQR, 249-434.75), and 370.5 (IQR, 243.25-418.25), respectively. The median intubation time was 39.5 hours (IQR, 19.25-68.5h) and the correlation with IL-8 values was positive: higher IL-8 concentrations in BAL fluid correlated with longer ventilation times (Spearman rank correlation, P=.007; rho=0.583). Five patients developed primary graft failure; IL-8 concentrations were significantly higher in these patients than in those whose grafts did not fail (Mann-Whitney test, P=.003).
Conclusion: High IL-8 concentrations in donor BAL fluid lead to longer ventilation time in the recipients and favor the development of primary graft failure after lung transplant.