Increased Donor Organ Size and Age is Associated with Reduced Survival in Female Lung Transplant Recipients.

BACKGROUND: Organ selection in lung transplantation (LTx) is still controversial. We here analyze the impact of mismatches in size, age, and gender on early and long-term outcome after LTx. METHODS: Retrospective analysis of donor and recipient characteristics of patients who underwent double LTx between March 2003 and December 2021. Statistical analysis was performed using SPSS and GraphPad software. RESULTS: Two hundred three patients were included (94 women and 109 men). In the whole cohort, oversizing donor organs 10% to 20% compared to the recipients' predicted total lung capacity led to a decreased incidence of severe Primary Graft Dysfunction grades 2 and 3 (2/3; 15% vs 41%, P = .03), and further oversizing > 20% was associated with reduced long-term survival (hazard ratio, 2.33, P = .011). Analyzing donor and recipient age, we found that increased donor age correlated with reduced long-term survival (P = .013). In this cohort, female recipients received older organs (median 57 vs 46 years, P = .0003) and had a higher incidence of > 20% oversizing (13% vs 4%, P = .019) of donor lungs, which resulted in a significantly reduced long-term survival (P = .02) compared with male recipients. Median Lung Allocation Scores were similar in both groups. CONCLUSION: Mismatch of donor age and size can be important for organ function and survival in LTx recipients. Particularly female recipients seem to have a higher risk for unfavorable long-term outcome when transplanting organs of increased size and age. Multicenter studies are warranted to further address this question. TRIAL REGISTRATION NUMBER: (DKRS): 00033312.

Lung Abscess and Recurrent Empyema After Infection With Mycoplasma hominis: A Case Report and Review of the Literature.

Mycoplasma hominis is a rarely identified cause of respiratory infection that can cause significant morbidity and mortality in immunocompromised patients. It is often missed due to the difficult detection of the organism with routine laboratory methods. We present the case of a 63-year-old male with a history of lymphoma who was transferred to our hospital with recurrent right-sided empyema and lung abscess in the right lower lobe. Advanced microbiological analysis finally revealed infection with M hominis. Despite appropriate antibiotic treatment, prolonged drainage as well as repeated surgery, which eventually resulted in right lower bilobectomy, were necessary for clinical improvement of our patient. Infection with M hominis may be more prevalent than previously indicated and can cause severe morbidity and mortality in thoracic surgery patients. Due to the diagnostic challenge, the appropriate antimicrobial treatment is often delayed. Inherent resistance to macrolides and inactivity of cell wall-active agents potentially complicate empiric antibiotic therapy. A review of the currently available literature enables a better understanding of the diagnostic difficulties and importance of this infection.