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The high risk heart donor: potential pitfalls
D A Bull1, R D Stahl, D L McMahan
1Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City 84132, USA.
Background:
The use of potentially infected donor hearts has been advocated to extend the supply of available hearts for transplantation.
Methods:
To determine whether bacterial transmission from donor to recipient can occur with heart transplantation, we reviewed our experience with the 347 patients who received 360 heart transplants in the Utah Transplant Affiliated Hospitals from 1988 to 1993.
Results:
During this time, nineteen donors had positive blood cultures before harvest. Sixteen donors had gram-positive bacteremia: Staphylococcus epidermidis (n = 9), Staphylococcus aureus (n = 5), streptococcus (n = 2). Two donors had gram-negative bacteremia: serratia (n = 1) and acinetobacter (n = 1). One donor had blood cultures positive for both Escherichia coli and streptococcus. Infectious complications occurred in two of three recipients who received a heart from a donor with gram-negative bacteremia: Escherichia coli endocarditis, mediastinitis, sepsis and death in one, and serratia sepsis and mediastinitis in another. In each case the organisms and sensitivities were identical between donor and recipient. No infectious complications related to the donor heart occurred among the 16 recipients who received hearts from donors with gram-positive bacteremia.
Conclusions:
(1) Bacterial transmission from donor heart to recipient can occur, (2) bacterial transmission appears to be more common with gram-negative organisms, and (3) infection of the recipient with a gram-negative organism from the donor heart is associated with significant morbidity and mortality.