*Purpose: We summarized the experience of diagnosis and treatment of donor-derived carbapene-resistant klebsiella pneumoniae (CRKP) infection after renal transplantation.

*Methods: From January 2015 to June 2018, 1246 renal transplant recipients were enrolled for samples screening. A total of 107 cases of Klebsiella pneumoniae (KPN) positive were detected in the perioperative biological samples including renal graft vascular cuff, graft perfusion fluid, wound drainage fluid, blood sample, sputum and urine, etc., and culture-based diagnosis with donor-derived CRKP was confirmed in 9 cases.

*Results: Nine cases were diagnosed with donor-derived CRKP infection through bacterial culture positive of graft artery samples collected pretransplantation and the same strains detected in wound drainage fluids of the recipients postoperation (more than 3 times). Drug sensibility testing showed that CRKP was resistant to most antibiotics except tigecycline and minocycline. Thus tigacycline based double or triple-combined anti-infective regimens (meropenem and/or ceftadin-avibatam/colistin/fosfomycin) were used to treat CRKP infection. Bacterial blood culture positive were found in 3 cases who underwent renal graft nephrotomy due to infectious renal artery rupture at 6 days, 7 days, and 10 days posttransplantation respectively. One patient has died of septic shock one week later after nephrotomy. And one 39-year-old male died of cerebrovascular accident after 12 days postoperation. The other 4 cases regained renal function, and were discharged after treatment for 2 to 12 weeks.

*Conclusions: Donor-derived CRKP infection, emerging as one of the most tough complication postoperation, could increase the incidence of graft loss secondary to infectious arteritis, or even worsen the survival of the recipients. Bacteria culture of graft vascular tissue could be beneficial for early diagnosis of infections derived from donation, and positive bacteria culture of blood samples of the recipients probably indicate poor prognosis. Combination of meropenem and ceftadin-abivudan would be a preferable protocol to control donor-derived CRKP infection.

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