A positive donor gram stain does not predict outcome following lung transplantation.
BACKGROUND
Many potential lung donors are excluded on the basis of a positive donor gram stain (DGS). We examined the association between a positive DGS and the probability of post-operative recipient pneumonia in the first 30 days.


METHODS
Ninety lung transplants (80 with a non-septic pre-transplant diagnosis) from 60 consecutive donors were evaluated for post-operative pneumonia (defined as a compatible clinical syndrome with fever, leukocytosis, chest X-ray abnormalities or histologic evidence obtained by transbronchial biopsy). DGS, white blood cell quantity, CXR and PaO(2)/FIO(2) (P/F) ratio were compared with immediate and 24-hour P/F ratio, length of mechanical ventilation and incidence of pneumonia. All recipients received standard prophylactic anti-bacterial coverage. Patients not surviving 30 days (n = 3) were excluded from this study, but none had evidence of pneumonia either by bronchoalveolar lavage (BAL), transbronchial biopsy or autopsy.


RESULTS
Fourteen (16%) of our 87 recipients developed pneumonia in the first 30 days after transplant. Of the 43 patients with a positive DGS, 5 (12%) developed pneumonia, compared to 9 of 44 (20%) with a negative DGS (p = 0.26). The mean post-operative P/F ratio (315 +/- 47 with a positive DGS, p = 0.3) and length of mechanical ventilation (2 days in each group) did not differ significantly between the negative and positive DGS groups.


CONCLUSIONS
In the current era of lung transplantation, DGS does not predict the development of early post-operative pneumonia and does not affect oxygenation or duration of mechanical ventilation; therefore, its role should be diminished when judging donor lung suitability.
Weill
David
D
Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. dweill@uab.edu
Dey
Gerald C
GC
Hicks
R Alan
RA
Young
K Randall
KR
Zorn
George L
GL
Kirklin
James K
JK
Early
Lesley
L
McGiffin
David C
DC
D006094:Gram-Positive Bacteria / Q000472:pathogenicity*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D011014:Pneumonia / Q000382:microbiology*; D011183:Postoperative Complications; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome