BACKGROUND
Aspiration is a relative contraindication to accepting donor lungs for transplant
and is currently assessed by visual inspection of the airways via bronchoscopy. However,
this method is limited as it does not assess for microaspiration. Bile acids measured
in large airway bronchial wash (LABW) samples have been shown to be a marker of aspiration
in lung transplant recipients. Herein, we investigate the utility of measuring total
bile acids (TBA) in donor LABW to predict performance of donor lungs and recipient
outcomes.
METHODS
TBA was measured in 605 consecutive lung donors at the Toronto Lung Transplant Program.
TBA levels were compared in donor lungs deemed unsuitable for transplant, requiring
further assessment on ex vivo lung perfusion (EVLP), and those suitable for direct
transplantation using Mann-Whitney-U tests. Relationships between LABW TBA concentrations
and recipient outcomes were evaluated using multivariable Cox-PH models and log-rank
analysis.
RESULTS
Donor TBA was highest in lungs deemed unsuitable for transplant and correlated with
clinical assessment of aspiration. LABW TBA concentration correlated with calcium,
decreased pH, and increased pro-inflammatory mediators in EVLP perfusate. TBA cut-off
of 1245 nM was able to differentiate donor lungs directly declined from those suitable
for direct transplantation with a 91% specificity (AUROC: 73%). High donor TBA status
was associated with the increased rate of primary graft dysfunction, longer time to
extubation, and shorter time to chronic lung allograft dysfunction.
CONCLUSIONS
In a large retrospective cohort, we observed that donor LABW TBA was associated with
suitability of donor lungs for transplant, performance of the organ on EVLP, and adverse
recipient outcomes.
KEYWORDS
Abbreviations:
TBA (total bile acids), LABW (large airway bronchial wash), EVLP (ex vivo lung perfusion), AUROC (area under the receiver operating characteristic curve)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 05, 2023
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© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
