RESUMO
Bacterial pneumonia is the most common cause of early morbidity and mortality (less than 2 weeks) after heart-lung transplantation. The majority (76%) of cultures taken from human donor tracheas at the time of explant grew bacteria. The abnormal immune response of the lung allograft and the common finding of bacterial contamination of lung donors led us to hypothesize that clinically silent bacterial contamination of the donor lung progresses to pneumonia in the recipient and that antibiotic treatment of donors will prevent the development of pneumonia in the recipient. Inocula of Streptococcus pneumoniae were instilled into the left middle lobe of normal and donor dogs to identify the number of bacteria that would result in pneumonia in a normal animal and the amount that, when given to a donor, would result in pneumonia in the recipient. Initial studies established that inocula of 10(4) colony-forming units of S. pneumoniae did not result in pneumonia in normal or immunosuppressed animals. When 10(4) colony-forming units or as few as 10(2) were instilled into the left middle lobe of donors 24 hours before explantation and use of the lung for transplantation, severe acute bronchopneumonia developed in all 18 recipients. Treatment of donors with aerosol and intravenous antibiotics, but not with either alone, prevented pneumonia in the recipients. We conclude that bacterial contamination of the donor lung leads to pneumonia in recipients. Intravenous and aerosol antibiotic treatment of donors with bacterial contamination prevents pneumonia in canine lung recipients. Treatment of human donors with this antibiotic regimen may decrease the prevalence of early bacterial pneumonia.
Assuntos
Antibacterianos/uso terapêutico , Transplante de Pulmão , Pneumonia Pneumocócica/etiologia , Pneumonia Pneumocócica/prevenção & controle , Administração por Inalação , Animais , Cães , Feminino , Infusões Intravenosas , Transplante de Pulmão/efeitos adversos , Doadores de Tecidos , Transplante HomólogoRESUMO
Early graft dysfunction in lung transplantation has many causes, most commonly preservation injury. This report details a more unusual cause of graft failure and respiratory decompensation in the early postoperative period donor cerebral emboli occluding segments of the pulmonary arterial tree in the implanted lung allografts of two patients who had received single lung implants from a common donor in whom massive cerebral trauma had been incurred in a motor vehicle accident. The incidence, complications, and clinical manifestations of cerebral emboli are discussed.