Outcome of Transplantation Using Organs From Donors Infected or Colonized With Carbapenem-Resistant Gram-Negative...

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Microbiology

Background:

• Donor-derived infections caused by multidrug-resistant bacteria (MDRB) are an increasing concern in solid organ transplantation.
• Optimal management strategies for recipients receiving organs from infected or colonized donors remain unclear.

Observation:

• During a 2-year period, 14% of recipients received organs from deceased donors harboring carbapenem-resistant gram-negative bacteria.
• High-risk recipients (47%) received organs from donors with bacteremia or infected/colonized transplanted organs.
• Low-risk recipients (53%) received organs from non-bacteremic donors with colonization of non-transplanted organs.

Findings:

• Proven transmission of MDRB occurred in 4 of 14 high-risk recipients due to unrecognized or poorly communicated donor infections.
• Inadequate post-transplant antibiotic therapy was associated with transmission in high-risk cases.
• Prompt and appropriate antibiotic therapy for at least 7 days prevented transmission in high-risk recipients.

Implications:

• Effective management of MDRB in deceased donors requires improved intra- and inter-institutional communication.
• Timely and appropriate recipient treatment is crucial to prevent donor-derived infection transmission.
• Safeguarding solid organ transplantation necessitates proactive strategies for managing MDRB transmission risks.