Impact of Multidrug-Resistant Organisms among Donors on Organ Utilization

J. A. Anesi¹, E. Lautenbach¹, J. H. Han¹, D. H. Lee², H. Clauss³, A. Climaco⁴, R. Hasz⁵, E. Molnar³, D. Alimenti¹, S. West⁵, W. B. Bilker¹, P. Tolomeo¹, E. A. Blumberg¹

¹University of Pennsylvania, Philadelphia, PA, ²Drexel University College of Medicine, Philadelphia, PA, ³Temple University, Philadelphia, PA, ⁴Albert Einstein Medical Center, Philadelphia, PA, ⁵Gift of Life Donor Program, Philadelphia, PA

Meeting: 2019 American Transplant Congress

Abstract number: A330

Keywords: Bacterial infection, Donors, marginal, Multivariate analysis

Session Information

Session Name: Poster Session A: Transplant Infectious Diseases

Session Type: Poster Session

Date: Saturday, June 1, 2019

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

*Purpose: Though transplant guidelines recommend exercising caution when considering donor organs that may be infected or colonized with multidrug-resistant organisms (MDROs), the true impact of such MDROs on organ utilization is unknown. We determined the impact of MDROs among organ donors on the number of organs transplanted per donor.

*Methods: A retrospective cohort study was conducted at four transplant centers in Philadelphia between 1/1/2015-6/30/2016. All deceased organ donors who donated ≥1 organ to one of the centers were included. Exposed donors had ≥1 MDRO on culture, including methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, and Gram-negative (GN) MDROs including extended-spectrum beta-lactamase (ESBL)-producing or carbapenem-resistant Enterobacteriaceae, multidrug-resistant (MDR) P. aeruginosa, and MDR Acinetobacter species. Unexposed donors had no MDRO-positive cultures. Cultures obtained during the terminal hospitalization, prior to organ procurement, were considered. Multivariable zero-truncated Poisson regression was used to determine the association between MDRO-positive donors and the number of organs utilized per donor.

*Results: Of 440 total donors, 62 (14.0%) donors grew 68 MDROs on culture. The majority were MRSA (40, 59%) or ESBL-Enterobacteriaceae (20, 29%). The most common site of MDRO growth was the respiratory tract (53, 78%). When all MDROs were included, there was not a significant association between MDRO on donor culture and the number of organs utilized (incidence rate ratio [IRR] 1.15, 95% confidence interval [CI] 0.99-1.33, P=0.07). However, presence of a GN MDRO on donor culture was associated with a significantly lower number of organs utilized per donor (IRR 0.48, 95% CI 0.28-0.81, P<0.01).

*Conclusions: The presence of any MDRO on donor culture did not significantly impact organ utilization, but the presence of a GN MDRO (such as ESBL-producing Enterobacteriaceae) reduced the number of organs utilized per donor by approximately 50%. Determining safe methods for using such organs will be essential to expanding the donor pool.

To cite this abstract in AMA style:

Anesi JA, Lautenbach E, Han JH, Lee DH, Clauss H, Climaco A, Hasz R, Molnar E, Alimenti D, West S, Bilker WB, Tolomeo P, Blumberg EA. Impact of Multidrug-Resistant Organisms among Donors on Organ Utilization [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-multidrug-resistant-organisms-among-donors-on-organ-utilization/. Accessed November 22, 2024.

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