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J Thorac Cardiovasc Surg 1995;109:1263-1264
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Infections and pathologic factors in the donor lung

University of Pittsburgh Medical Center
Pittsburgh, PA 15213-2583

To the Editor:

We read with interest the article by Low and associates, ¹ titled, "The Donor Lung: Infectious and Pathologic Factors Affecting Outcome in Lung Transplantation." We disagree with a number of the points made in the discussion of the article. Low and associates correctly stated that we treat lung donors with intravenous and aerosolized antibiotics to decrease the prevalence of early bacterial pneumonia in the recipient of lung allografts. This approach is based on experimental data that demonstrate a decreased incidence of pneumonia in the recipient when contaminated donor lungs are treated with this antibiotic combination. ² Low and colleagues incorrectly stated that after this regimen was initiated, intrathoracic infection developed in 16 of 37 recipients. This was the incidence of intrathoracic infection in our recipients before this regimen was begun. Since we began treating our recipients with combined intravenous and aerosolized antibiotics we have noted a significant decrease in the incidence of early intrathoracic infection and, in particular, a decreased incidence of early bacterial pneumonia. From 1991 to 1993 inclusive, early bacterial pneumonia developed in 11 of 187 recipients (5.9%). In 1993, early bacterial pneumonia developed in one of 68 recipients (1.5%).

The authors also hypothesize: "Treatment of the donors before lung retrieval may temporarily suppress tracheobronchial flora and make the assessment of significant infection at the time of harvest more subject to error." This is not true because appropriate cultures can be taken before donor antibiotic therapy is begun.

We also disagree with the statement: "Proof of invasive infection in donor lungs indicates the need for expedient and specific treatment to avoid progression of the infectious process after implantation." We believe that the presence of invasive infection in a donor lung should be a contraindication to the use of those lungs for transplantation. Indeed, in Low's series, pneumonia developed in all four recipients who received lungs from donors that had histologic evidence of pneumonia.

12/8/58952

References

1. Low DE, Kaiser LR, Haydock DA, Trulock E, Cooper JD. The donor lung: infectious and pathologic factors affecting outcome in lung transplantation. J THORAC CARDIOVASC SURG 1993;106:614-21.[Abstract]
   
2. Dowling RD, Zenati M, Yousem SA, et al. Donor transmitted pneumonia in experimental allografts: successful prevention with donor antibiotic therapy. J THORAC CARDIOVASC SURG 1992;103:767-72.[Abstract]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Robert D. Dowling Marco Zenati Bartley P. Griffith Robert L. Hardesty Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dowling, R. D. Articles by Hardesty, R. L. Search for Related Content PubMed PubMed Citation Articles by Dowling, R. D. Articles by Hardesty, R. L.