Journal of thoracic disease · 2026
Dangerous liaisons: the peri-transplant respiratory microbiota and their impact on lung transplantation outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Vorstandlechner Maximilian, Walter Julia, Bauer Mara A, Steybe David, Fertmann Jan M, Schneider Christian P, Michel Sebastian, Barton Jürgen, Schroeder Ines, Yavuz Gökce, Glueck Olaf M, Weber Alexandra, Smolka Wenko, Kauke Teresa, Obermeier Katharina Theresa
Аннотация
BACKGROUND: Despite advances in immunosuppression and perioperative care, lung transplantation (LuTX) outcome continues to be limited by allograft rejection and infectious complications. Given the allograft's direct exposure to the environment, peri-transplant microbial presence and dynamics may critically shape outcomes, yet its impact remains incompletely understood. This study aimed to evaluate peri-transplant airway microbiological findings in lung transplant recipients and determine their associations with acute cellular rejection (ACR), chronic lung allograft dysfunction (CLAD), and survival.
METHODS: We retrospectively analyzed 345 LuTX recipients treated between 2014 and 2019 with follow-up through 2024. Standardized microbiological sampling was performed pre-, intra- and postoperatively. Associations with ACR, CLAD and survival were evaluated.
RESULTS: Candida species (spp.) (22.6% and 18.3%, respectively) and Pseudomonas aeruginosa (10.7% and 7.2%) were most frequently detected in pre- and postoperative sputum samples. Donor lungs showed positive microbial samples in 62.3% of cases, predominantly with Candida spp. (31.3%) and Staphylococcus spp. (26.1%). Multivariate analysis identified donor-derived Escherichia coli as an independent predictor of ACR (P=0.01; odds ratio 3.2), CLAD [P=0.03; hazard ratio (HR) 2.6] and impaired survival (P<0.001; HR 3.2). Furthermore, donor-derived Achromobacter spp. (P=0.01; HR 13.6) and postoperative deep airway Candida detection (P=0.045; HR 1.9) predicted mortality. While Klebsiella was associated with adverse outcomes in univariate analysis, this did not remain significant after adjustment.
CONCLUSIONS: Peri-transplant airway microbiota are significantly associated with graft rejection and survival after LuTX. Donor-derived E. coli and Achromobacter spp., as well as postoperative Candida detection, emerged as robust predictors of poor outcome. Systematic microbiological surveillance and tailored prophylaxis are essential to mitigate microbial-driven allograft dysfunction and improve long-term survival.
METHODS: We retrospectively analyzed 345 LuTX recipients treated between 2014 and 2019 with follow-up through 2024. Standardized microbiological sampling was performed pre-, intra- and postoperatively. Associations with ACR, CLAD and survival were evaluated.
RESULTS: Candida species (spp.) (22.6% and 18.3%, respectively) and Pseudomonas aeruginosa (10.7% and 7.2%) were most frequently detected in pre- and postoperative sputum samples. Donor lungs showed positive microbial samples in 62.3% of cases, predominantly with Candida spp. (31.3%) and Staphylococcus spp. (26.1%). Multivariate analysis identified donor-derived Escherichia coli as an independent predictor of ACR (P=0.01; odds ratio 3.2), CLAD [P=0.03; hazard ratio (HR) 2.6] and impaired survival (P<0.001; HR 3.2). Furthermore, donor-derived Achromobacter spp. (P=0.01; HR 13.6) and postoperative deep airway Candida detection (P=0.045; HR 1.9) predicted mortality. While Klebsiella was associated with adverse outcomes in univariate analysis, this did not remain significant after adjustment.
CONCLUSIONS: Peri-transplant airway microbiota are significantly associated with graft rejection and survival after LuTX. Donor-derived E. coli and Achromobacter spp., as well as postoperative Candida detection, emerged as robust predictors of poor outcome. Systematic microbiological surveillance and tailored prophylaxis are essential to mitigate microbial-driven allograft dysfunction and improve long-term survival.