Plasma (1→3)-β-D-glucan increase caused by the use of large amounts of gauze during a lung transplant operation

Abstract

The determination of plasma (1→3)-β-D-glucan is widely used for the diagnosis of deep mycosis, but it is often affected by various factors. We experienced a case with markedly increased plasma (1→3)-β-D-glucan after bilateral lung transplantation for pulmonary lymphangiomyomatosis. The patient's plasma (1→3)-β-D-glucan increased up to 2964 pg/ml the day after transplantation. We searched for the reason for this increase and it was suspected that blood from the surgical field, which contained gauze, returning to the circulation through a heart-lung machine might have caused the increase in plasma (1→3)-β-D-glucan. To examine this hypothesis, we experimentally measured the (1→3)-β-D-glucan level in saline in which gauze had been immersed. The result implies that (1→3)-β-D-glucan might have been eluted from the gauze. If large amounts of gauze are used in the surgical field and the blood aspirated is returned to the circulation, the postoperative plasma (1→3)-β-D-glucan level should be carefully interpreted.