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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2020 June;86(6):617-26

DOI: 10.23736/S0375-9393.20.13840-9


language: English

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

Vito FANELLI 1 , Lorenzo DEL SORBO 2, Massimo BOFFINI 3, Andrea COSTAMAGNA 4, Stefano BALZANO 1, Tiziana MUSSO 5, Sara SCUTERA 5, Paola CAPPELLO 6, Anna MAZZEO 1, Paolo SOLIDORO 7, Lorena BAIETTO 8, Antonio D’AVOLIO 8, Francesco G. DEROSA 8, Luca BRAZZI 1, Luciana MASCIA 9, Mauro RINALDI 3, V. Marco RANIERI 10

1 Division of Anesthesia and Critical Care Medicine, Department of Surgical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy; 2 Division of Respirology and Critical Care Medicine, Department of Medicine, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; 3 Division of Cardiac Surgery and Lung Transplantation, Department of Surgical Science, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy; 4 Department of Anesthesia and Critical Care, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy; 5 Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy; 6 Department of Molecular Biotechnologies and Health Sciences, University of Turin, Turin, Italy; 7 Division of Pneumology U, AOU Città della Salute e della Scienza, Turin, Italy; 8 Department of Medical Sciences and Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy; 9 Department of Science and Medical-Surgical Biotechnology, Sapienza University, Latina, Rome, Italy; 10 Department of Medical and Surgical Sciences, Anesthesia, and Intensive Care Medicine, Sant’Orsola Polyclinic Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy

BACKGROUND: Normothermic 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.
METHODS: Imipenem 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.
RESULTS: Imipenem 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.
CONCLUSIONS: Recipients 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.

KEY WORDS: Ventilation-perfusion scan; Lung transplantation; Imipenem; Pharmacokinetics; Pneumonia; Cytokines

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