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Impact of perioperative airway pathogens on living-donor lobar lung transplantation outcomes

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Abstract

Purpose

To elucidate the clinical impact of pathogenic organism (PO) positivity early after transplantation, we evaluated the impact of perioperative airway POs on outcomes after living-donor lobar lung transplantation (LDLLT), where the graft airway is supposed to be sterile from a healthy donor.

Method

A retrospective review of 67 adult LDLLT procedures involving 132 living donors was performed. Presence of POs in the recipients’ airways was evaluated preoperatively and postoperatively in intensive-care units.

Results

POs were detected preoperatively in 13 (19.4%) recipients. No POs were isolated from the donor airways at transplantation. POs were detected in 39 (58.2%) recipients postoperatively; most were different from the POs isolated preoperatively. Postoperative PO isolation was not associated with short-term outcomes other than prolonged postoperative ventilation. The 5-year overall survival was significantly better in the PO-negative group than in the PO-positive group (89.1% vs. 63.7%, P = 0.014). In the multivariate analysis, advanced age (hazard ratio [HR]: 1.041 per 1-year increase, P = 0.033) and posttransplant PO positivity in the airway (HR: 3.684, P = 0.019) significantly affected the survival.

Conclusions

The airways of the living-donor grafts were microbiologically sterile. PO positivity in the airway early after transplantation negatively impacted long-term outcomes.

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Abbreviations

Abx:

Antibiotic drug

BMI:

Body mass index

BOS:

Bronchiolitis obliterans syndrome

CI:

Confidence interval

CLAD:

Chronic lung allograft dysfunction

DDLT:

Deceased-donor lung transplantation

HR:

Hazard ratio

ICU:

Intensive-care unit

IVIG:

Intravenous immunoglobulin

LDLLT:

Living-donor lobar lung transplantation

LOS:

Length of stay

OS:

Overall survival

PO:

Pathogenic organism

POD:

Postoperative day

PTLD:

Posttransplant lymphoproliferative disorders

RAS:

Restrictive allograft syndrome

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Acknowledgements

This work was supported by the SPIRITS 2021 of Kyoto University and the Japan Society for the Promotion of Science KAKENHI (20H03769).

Funding

This work was supported by SPIRITS 2021 of Kyoto University and Japan Society for the Promotion of Science KAKENHI (20H03769).

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto City, Kyoto, 606-8507, Japan

    Hiromi Oda, Satona Tanaka, Toyofumi F. Chen-Yoshikawa, Yuki Morimura, Yoshito Yamada, Yojiro Yutaka, Daisuke Nakajima, Masatsugu Hamaji, Akihiro Ohsumi, Toshi Menju & Hiroshi Date

  2. Department of Thoracic Surgery, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-Ku, Osaka City, Osaka, 530-8480, Japan

    Hiromi Oda

  3. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya City, Aichi, 466-8560, Japan

    Toyofumi F. Chen-Yoshikawa

  4. Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto City, Kyoto, 606-8507, Japan

    Miki Nagao

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  1. Hiromi Oda
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Contributions

HO conceived the primary hypothesis, designed the research, collected and analyzed the data, and wrote the manuscript. ST conceived the primary hypothesis, designed the research, analyzed the data, and wrote the manuscript. TFCY conceived the primary hypothesis, designed the research, and wrote the manuscript. Y. collected and analyzed the data and wrote the manuscript. YY, YY, DN, MH, AO, and TM contributed to the methodology and edited the manuscript. MN analyzed the data, contributed to the methodology, and edited the manuscript. HD supervised the research and edited the manuscript.

Corresponding author

Correspondence to Satona Tanaka.

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Conflict of interest

No authors have any conflicts of interest related to this work.

Informed patient consent/consent to publication

This study was approved by the Institutional Review Board of the Kyoto University Hospital (R2389), and informed consent was waived because of the retrospective nature of the study. Opt-out was not requested from any patients.

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Oda, H., Tanaka, S., Chen-Yoshikawa, T.F. et al. Impact of perioperative airway pathogens on living-donor lobar lung transplantation outcomes. Surg Today 54, 266–274 (2024). https://doi.org/10.1007/s00595-023-02730-9

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  • DOI: https://doi.org/10.1007/s00595-023-02730-9

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