The Lung Allograft Microbiome Associates with Pepsin, Inflammation, and Primary Graft Dysfunction

• Published in: American journal of respiratory and critical care medicine Vol. 206; no. 12; pp. 1508 - 1521
• Main Authors: McGinniss, John E., Whiteside, Samantha A., Deek, Rebecca A., Simon-Soro, Aurea, Graham-Wooten, Jevon, Oyster, Michelle, Brown, Melanie D., Cantu, Edward, Diamond, Joshua M., Li, Hongzhe, Christie, Jason D., Bushman, Frederic D., Collman, Ronald G.
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.12.2022
• Subjects: Allografts; Cytokines; Humans; Inflammation - complications; Liver diseases; Lung; Lung cancer; Lung diseases; Lung Transplantation - adverse effects; Microbiota; Original; Pepsin A; Primary Graft Dysfunction - etiology; Prospective Studies; Transplants & implants; lung transplantation; host–microbe interactions; microbiome; primary graft dysfunction
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.202112-2786OC

Primary graft dysfunction (PGD) is the principal cause of early morbidity and mortality after lung transplantation. The lung microbiome has been implicated in later transplantation outcomes but has not been investigated in PGD. To define the peritransplant bacterial lung microbiome and relationship to host response and PGD. This was a single-center prospective cohort study. Airway lavage samples from donor lungs before organ procurement and recipient allografts immediately after implantation underwent bacterial 16S ribosomal ribonucleic acid gene sequencing. Recipient allograft samples were analyzed for cytokines by multiplex array and pepsin by ELISA. We enrolled 139 transplant subjects and obtained donor lung (  = 109) and recipient allograft (  = 136) samples. Severe PGD (persistent grade 3) developed in 15 subjects over the first 72 hours, and 40 remained without PGD (persistent grade 0). The microbiome of donor lungs differed from healthy lungs, and recipient allograft microbiomes differed from donor lungs. Development of severe PGD was associated with enrichment in the immediate postimplantation lung of oropharyngeal anaerobic taxa, particularly . Elevated pepsin, a gastric biomarker, and a hyperinflammatory cytokine profile were present in recipient allografts in severe PGD and strongly correlated with microbiome composition. Together, immediate postimplantation allograft / ratio, pepsin, and indicator cytokines were associated with development of severe PGD during the 72-hour post-transplantation period (area under the curve = 0.81). Lung allografts that develop PGD have a microbiome enriched in anaerobic oropharyngeal taxa, elevated gastric pepsin, and hyperinflammatory phenotype. These findings suggest a possible role for peritransplant aspiration in PGD, a potentially actionable mechanism that warrants further investigation.