Am. J. Respir. Crit. Care Med., Volume 163, Number 1, January 2001, 259-265

Elevated Levels of Interleukin-8 in Donor Lungs Is Associated with Early Graft Failure after Lung Transplantation

ANDREW J. FISHER, SEAMAS C. DONNELLY, NIKHIL HIRANI, CHRISTOPHER HASLETT, ROBERT M. STRIETER, JOHN H. DARK, and PAUL A. CORRIS

Departments of Respiratory Medicine and Cardiopulmonary Transplantation, Freeman Hospital, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom; Respiratory Medicine Unit, Rayne Laboratory, University of Edinburgh Medical School, Edinburgh, Scotland; Picower Institute, Manhasset, New York; and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

Increased levels of the neutrophil chemokine interleukin (IL)-8 in the lungs of severe trauma patients can predict subsequent development of acute respiratory distress syndrome. Because the lungs of brain-dead organ donors can contain high levels of IL-8, we hypothesized that this may predispose to early graft failure in the recipient after lung transplantation. Twenty-six organ donors prospectively satisfying clinical criteria for lung donation underwent bronchoalveolar lavage and lung biopsy to determine the effect of neutrophil infiltration and IL-8 expression in the donor lung on graft function and survival in 26 respective recipients after lung transplantation. Nine recipients developed severe graft dysfunction, of whom six subsequently died (median survival: 24 d [range: 5 to 39 d]); all others survived beyond 6 mo. The IL-8 signal in the donor lung correlated with the percent neutrophils in bronchoalveolar lavage fluid (BALF) before implantation (42.4 ± 7.24 [mean ± SE]%, p = 0.03) and with the degree of impairment in graft oxygenation after implantation (p = 0.01). An increased level of IL-8 in the donor BALF was associated with the development of severe early graft dysfunction (p = 0.027) and with early recipient mortality (p = 0.0034). Use of donor lungs with high IL-8 levels is associated with a poor prognosis after lung transplantation. Attenuating the donor's inflammatory response before organ retrieval may improve early outcome after lung transplantation, and help maximize lung use from the existing donor pool.

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