*Purpose: Infections are the primary cause of morbidity and mortality after solid organ transplantation. Due to high incidence of lung graft colonization with multi drug resistant organisms, King Faisal Specialist Hospital & Research Center upgraded their antibacterial prophylaxis protocol to include colistin, meropenem and vancomycin. Our aim is to evaluate the safety and efficacy of this regimen in reducing the incidence of donor derived infections and improving patient and graft survival post lung transplantation.

*Methods: Retrospective case control study, included all adult lung transplant recipients with multi drug resistant colonized grafts who underwent lung transplantation from 2010-2019 (study group) compared to those in the same time period without multi-drug resistant colonization (control group). Pediatrics, multi-organ transplantat recipients, and patients who died within 24-hours due to technical reasons will be excluded. The primary outcome was the rate of donor derived bacterial infections in the first month post lung transplantation. Secondary outcomes included graft and patient 6- and 12-month survival, ECMO requirement post transplantation, rate of re-hospitalization in the first 6 months post transplantation, and safety outcomes (acute kidney injury, neurotoxicity and clostridium difficile infection). A non-inferiotity analysis for the differences between the groups in primary and seconday outcomes will be conducted, with regression analysis to assess the effect of different baseline variables on the outcomes.

*Results: Preliminary analysis of 31 patients (16 in study group and 15 controls), patients in the study group were younger than the control group (36.75±11.34 vs. 41.60±14.85 years; p=NS). The most common indication for lung transplantation is idiopathic interstitial pneumonia (control 40% and study 31.25%). Donor-derived infections occurred in 10 patients in the study group (62.50%) vs. 8 of the control (53.33%); p= NS. Patients in the study group required approximately 5 times more ECMO post-transplantation than controls. Six- and 12- month survival was 100% in both groups.

*Conclusions: As expected, numerically, the rate of donor deriver infections is higher in the study group. However, conclusions cannot be drawn until complete analysis of study cohort.

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