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Minerva Anestesiologica 2020 Jan 27

DOI: 10.23736/S0375-9393.20.13840-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Impact of imipenem concentration in lung perfusate and tissue biopsy during clinical ex vivo lung perfusion (EVLP) 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 Department of Surgical Science, Division of Anesthesia and Critical Care Medicine, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy; 2 Department of Medicine, Division of Respirology and Critical Care Medicine, Toronto General Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada; 3 Department of Surgical Science, Division of Cardiac Surgery and Lung Transplantation, University of Turin, AOU Città della Salute e della Scienza di Torino, 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 S.C. Pneumologia U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy; 8 Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy; 9 Department of Science and Medical Surgical Biotechnology, Università La Sapienza di Roma, Latina, Italy; 10 Alma Mater Studiorum, Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy


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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. pneumonia 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 (IL6) and 8 (IL8) 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. Donor+/Recipient+ group (26% of cases) had higher IL6 and IL8 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: Ex-vivo lung perfusion; Lung transplantation; Imipenem; Pharmacokinetic; Pneumonia; Cytokines

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