本期胸小星将为大家带来肺移植供体和受体呼吸道筛查及受体结局的前瞻性研究；肺移植前Th2免疫反应的循环指标变化与原发性移植物失功减少相关，一起来看看吧！
2017·EATTS
01
Patrick C K Tam1, Barbara D Alexander2, Mark J Lee3, Rochelle G Hardie4, John M Reynolds5, John C Haney6, Ken B Waites7, John R Perfect8, Arthur W Baker9
1 Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
2 Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA.
3 Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA.
4 Division of Infectious Diseases, College of Medicine, University of Florida, Gainesville, Florida, USA.
5 Department of Medicine, Transplant Pulmonology, Duke University School of Medicine, Durham, North Carolina, USA.
6 Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
7 Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
8 Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
9 Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
Backgrounds:
Mycoplasma hominis and Ureaplasma species are urogenital mollicutes that can cause serious donor-derived infections in lung transplant recipients. Best practices for mollicute screening remain unknown.
Methods:
We conducted a single center prospective study analyzing lung transplants performed from 10/5/20 - 9/5/21 whereby donor and recipient bronchoalveolar lavage (BAL) samples obtained at time of transplant underwent mollicute screening via culture and polymerase chain reaction (PCR).
Results:
Of 115 total lung transplants performed, 99 (86%) donors underwent combined mollicute BAL culture and PCR testing. The study cohort included these 99 donors and their matched recipients. In total, 18 (18%) of 99 donors screened positive via culture or PCR. Among recipients, 92 (93%) of 99 had perioperative BAL screening performed, and only 3 (3%) had positive results. After transplant, 9 (9%) recipients developed mollicute infection. Sensitivity of donor screening in predicting recipient mollicute infection was 67% (6/9) via culture and 56% (5/9) via PCR. Positive predictive value (PPV) for donor culture was 75% (6/8), compared to 33% (5/15) for PCR.
Conclusions:
Donor screening via culture predicted all serious recipient mollicute infections and had better PPV than PCR; however, neither screening test predicted all mollicute infections. Independent of screening results, clinicians should remain suspicious for post-transplant mollicute infection.
[CITATION]: Tam PCK, Alexander BD, Lee MJ, et al. Donor-Derived Mycoplasma and Ureaplasma Infections in Lung Transplant Recipients: A Prospective Study of Donor and Recipient Respiratory Tract Screening and Recipient Outcomes. Am J Transplant. 2024 Jul 16:S1600-6135(24)00436-2.
[DOI]: 10.1016/j.ajt.2024.07.013.
[IF]:8.9
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肺移植受者中供体源性支原体和脲原体感染：一项供体和受体呼吸道筛查及受体结局的前瞻性研究
胸“星”外科学术团队兴趣小队成员 李雨晨 译
背景
方法
本研究是一项单中心前瞻性研究，纳入了2020年5月10日至2021年5月9日期间行肺移植的患者。通过培养和聚合酶链反应（polymerase chain reaction, PCR）对移植时所获供体和受体支气管肺泡灌洗液（bronchoalveolar lavage, BAL）样本进行了支原体筛查。
结果
结论
Table3. Pertormance of donor BAL screening tests used to predict post-transplant recipient mollicute infection for 99 donors who were screened by culture and PCR.
Table 4. Summary of 9 lung transplant recipients with early post-transplant mollicute infection and results of donor BAL screening.
2017·EATTS
02
Alterations in Circulating Measures of Th2 Immune Responses Pre-Lung Transplant Associates with Reduced Primary Graft Dysfunction
Joanna Schaenman1, S. Sam Weigt2, Mengtong Pan3, Joshua J. Lee3, Xinkai Zhou3, David Elashoff3, Mike Shino2, John M. Reynolds4, Marie Budev5, Pali Shah6, Lianne G. Singer4, Jamie L. Todd4, Laurie D. Snyder4, Scott Palmer4, John Belperio2
1 Division of Infectious Diseases. Electronic address: jschaenman@mednet.ucla.edu.
2 Division of Pulmonary, Critical Care, and Sleep Medicine.
3 Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA.
4 Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine.
5 Department of Pulmonary Medicine, Cleveland Clinic.
6 Division of Pulmonary Medicine, Johns Hopkins School of Medicine.
Background:
Primary graft dysfunction (PGD) is a complication of lung transplantation that continues to cause significant morbidity. The Th2 immune response has been shown to counteract tissue-damaging inflammation. We hypothesized that Th2 cytokines/chemokines in blood would be associated with protection from PGD.
Methods:
Utilizing pre-transplant sera from the multicenter Clinical Trials in Organ Transplantation (CTOT-20) study, we evaluated Th2 cytokines/chemokines in 211 patients.
Results:
Increased concentrations of Th2 cytokines were associated with freedom from PGD, namely IL-4 (Odds Ratio (OR) 0.66 (95% CI 0.45-0.99), P = 0.043), IL-9 (OR 0.68 (95% CI 0.49-0.94), P = 0.019), IL-13 (OR 0.73 (95% CI 0.55-0.96), P = 0.023), and IL-6 (OR 0.74 (95% CI 0.56-0.98), P = 0.036). Multivariable regression performed for each cytokine including clinically relevant covariables confirmed these associations and additionally demonstrated association with IL-5 (OR 0.57 (95% CI 0.36-0.89), P = 0.014) and IL-10 (OR 0.55 (95% CI 0.32-0.96), P = 0.035).
Conclusion:
Higher levels of Th2 immune response prior to lung transplant appear to have a protective effect against PGD, which parallels the Th2 role in resolving inflammation and tissue injury. Pre-transplant cytokine assessments could be utilized for recipient risk stratification.
[CITATION]: Schaenman J, Weigt SS, Pan M, et al. Alterations in Circulating Measures of Th2 Immune Responses Pre-Lung Transplant Associates with Reduced Primary Graft Dysfunction. J Heart Lung Transplant. 2024 Jul 17:S1053-2498(24)01744-3.
[DOI]: 10.1016/j.healun.2024.07.011.
[IF]: 6.4
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肺移植前Th2免疫反应的循环指标变化与原发性移植物失功减少相关
胸“星”外科学术团队兴趣小队成员 谭媛媛 译
背景
方法
结果
结论
Table 2. Univariate and Multivariable Analysis of Cytokine Association with PGD
2017·EATTS
