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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Outcomes in solid organ transplant recipients receiving organs from a donor with Fusarium solani species complex
Isabel S Griffin1, Dallas J Smith2, Pallavi Annambhotla1
1Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Background:
Five organs (heart, right lung, liver, right, and left kidneys) from a deceased patient were transplanted into five recipients in four US states; the deceased patient was identified as part of a healthcare-associated fungal meningitis outbreak among patients who underwent epidural anesthesia in Matamoros, Mexico.
Methods:
After transplant surgeries occurred, Fusarium solani species complex, a fungal pathogen with a high case-mortality rate, was identified in cerebrospinal fluid from the organ donor by metagenomic next-generation sequencing (mNGS) and fungal-specific polymerase chain reaction and in plasma by mNGS.
Results:
Four of five transplant recipients received recommended voriconazole prophylaxis; four were monitored weekly by serum (1-3)-β-d-glucan testing. All five were monitored for signs of infection for at least 3 months following transplantation. The liver recipient had graft failure, which was attributed to an etiology unrelated to fungal infection. No fungal DNA was identified in sections of the explanted liver, suggesting that F. solani species complex did not contribute to graft failure. The remaining recipients experienced no signs or symptoms suggestive of fusariosis.
Conclusion:
Antifungal prophylaxis may be useful in preventing donor-derived infections in recipients of organs from donors that are found to have Fusarium meningitis.
Insights
Antifungal prophylaxis may prevent fungal infections in organ transplant recipients from donors with Fusarium meningitis. This study monitored recipients for infection after transplantation, finding no invasive fusariosis in those receiving prophylaxis.
Area of Science:
- Infectious Diseases
- Transplant Surgery
- Mycology
Background:
- A deceased organ donor was linked to a fungal meningitis outbreak following epidural anesthesia in Mexico.
- The donor's organs were transplanted into five recipients across four US states.
Purpose of the Study:
- To assess the risk of donor-derived fungal infections in organ transplant recipients.
- To evaluate the effectiveness of antifungal prophylaxis in preventing such infections.
Main Methods:
- Donor cerebrospinal fluid and plasma were analyzed using metagenomic next-generation sequencing (mNGS) and PCR, identifying Fusarium solani species complex.
- Organ recipients received voriconazole prophylaxis and were monitored for infection signs and serum (1-3)-β-d-glucan levels.
Main Results:
- Four of five recipients received voriconazole prophylaxis and were monitored weekly.
- No recipient developed signs or symptoms of fusariosis; one liver recipient experienced graft failure unrelated to fungal infection.
Conclusions:
- Antifungal prophylaxis may be beneficial in preventing donor-derived Fusarium infections in organ transplant recipients.
- Early detection and prophylactic treatment are crucial in managing potential infections from contaminated donor organs.
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