• Minerva anestesiologica · Jun 2020

    Impact of imipenem concentration in lung perfusate and tissue biopsy during clinical ex vivo lung perfusion (EVLP) of high-risk lung donors.

    • Vito Fanelli, Lorenzo Del Sorbo, Massimo Boffini, Andrea Costamagna, Stefano Balzano, Tiziana Musso, Sara Scutera, Paola Cappello, Anna Mazzeo, Paolo Solidoro, Lorena Baietto, Antonio D'avolio, Francesco G Derosa, Luca Brazzi, Luciana Mascia, Mauro Rinaldi, and V Marco Ranieri.
    • Division of Anesthesia and Critical Care Medicine, Department of Surgical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy - vito.fanelli@unito.it.
    • Minerva Anestesiol. 2020 Jun 1; 86 (6): 617-626.

    BackgroundNormothermic ex-vivo lung perfusion (EVLP) limits organ donor shortage by potentially using high-risk donor lungs. Microbial burden reduction has been demonstrated after EVLP using antibiotic prophylaxis with imipenem. However, no data have been published on the clinical consequences of the potential residual bacterial burden.MethodsImipenem concentration was measured every hour (T0 to T6) in the lung perfusate and at the end of EVLP (Tf) in biopsies. The antimicrobial activity of perfusate at T1 and Tf against E. coli and K. pneumoniae was evaluated. Lungs were distinguished: no bacterial species in recipients and donors (donor-/recipient-); bacterial species isolated from donors and not from recipients (donor+/recipient-); same bacterial species in both recipients and donors (donor+/recipient+). Interleukin 6 (IL-6) and IL-8 concentrations in lung perfusate, clinical pulmonary infection score (CPIS) and primary graft dysfunction (PGD) were evaluated.ResultsImipenem concentration in perfusate decreased over time. T1 and Tf perfusates exhibited bactericidal activity against E. coli and K. pneumoniae. Overall, T1 perfusates yielded higher bactericidal titers (BTs) than Tf. The donor+/recipient+ group (26% of cases) had higher IL-6 and IL-8 in perfusate and higher CPIS.ConclusionsRecipients with the same bacterial species isolated in their donors had higher risk of pulmonary inflammation and early post-transplant pneumonia. Improvements in antimicrobial strategies during EVLP are warranted to minimize the consequences of donor associated respiratory infection.

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