title: The effect of ex vivo lung perfusion on microbial load in human donor lungs.
abstract: BACKGROUND
  Ex vivo lung perfusion (EVLP) has emerged as a technique to potentially recondition unusable donor lungs for transplantation. Beneficial effects of EVLP on physiologic function have been reported, but little is known about the effect of normothermic perfusion on the infectious burden of the donor lung. In this study, we investigated the effect of EVLP on the microbial load of human donor lungs.
  
  
  METHODS
  Lungs from 18 human donors considered unusable for transplantation underwent EVLP with a perfusate containing high-dose, empirical, broad-spectrum anti-microbial agents. Quantitative cultures of bacteria and fungi were performed on bronchoalveolar lavage fluid from the donor lung before and after 3 to 6 hours of perfusion. The identification of any organisms and changes in number of colony forming units before and after EVLP were assessed and anti-microbial susceptibilities identified.
  
  
  RESULTS
  Thirteen out of 18 lungs had positive cultures, with bacterial loads significantly decreasing after EVLP. Yeast loads increased when no anti-fungal treatment was given, but were reduced when prophylactic anti-fungal treatment was added to the circuit. Six lungs were ultimately transplanted into patients, all of whom survived to hospital discharge. There was 1 death at 11 months.
  
  
  CONCLUSIONS
  Our study shows that EVLP with high-dose, empirical anti-microbial agents in the perfusate is associated with an effective reduction in the microbial burden of the donor lung, a benefit that has not previously been demonstrated.
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Anders
authors.initials: A
authors.lastname: Andreasson
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne.
authors.forename: Danai M
authors.initials: DM
authors.lastname: Karamanou
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne; Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Perry
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Audrey
authors.initials: A
authors.lastname: Perry
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Faruk
authors.initials: F
authors.lastname: Ӧzalp
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Butt
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Morley
authors.affiliation: Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Walden
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Clark
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Prabhu
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Corris
authors.affiliation: Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: Kate
authors.initials: K
authors.lastname: Gould
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne. Electronic address: a.j.fisher@ncl.ac.uk.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Fisher
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne; Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne.
authors.forename: John H
authors.initials: JH
authors.lastname: Dark
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000494:pharmacology; D058491:Bacterial Load; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000382:microbiology*; D016040:Lung Transplantation / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000592:standards*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: antibiotics; donor lung; ex vivo lung perfusion; fungicides; lung transplantation; microbiology