*Purpose: As survival time of solid organ transplant recipients (SOTR) increases, comorbidities associated with advancing age such as diabetes mellitus and peripheral arterial disease combined with immunosuppression can increase the risk of osteomyelitis (OM). There is a gap in knowledge regarding optimal treatment of OM in SOTR. In this study we aim to describe the clinical features, treatment, and outcomes of post-transplant (TXP) OM in SOTR in our institution.

*Methods: We performed a retrospective chart review of SOTR age ≥ 18 years transplanted between 1/2013-7/2018 who were diagnosed and treated for a first episode of post-TXP OM. Recipients who underwent a repeat TXP, were transplanted at another center, or were treated for OM at a different center were excluded. Outcomes measured included diagnosis of re-infection of OM at the same site or a new diagnosis of OM at a different site after antibiotics were completed.

*Results: Of 1061 SOTR included in the study, 20 developed post-TXP OM, with 15 meeting inclusion criteria. Eleven were renal recipients, 3 heart, and 1 renal/heart. The most common immunosuppressive medications included prednisone (100%), tacrolimus (80%), and mycophenolate (80%). Median age at diagnosis of OM was 57 years [34-69]. Diabetes was present in 14 SOTR and peripheral arterial disease in 7. Five had an episode of treated OM before TXP. Median time from TXP to diagnosis of OM was 390 days [100-1517]. The most common site of infection was the lower extremities (80%). Staphylococcus aureus was the most common isolated organism (53%). Twelve SOTR underwent surgical management; six had curative surgery and received a median of 11 days [4-14] of post-surgical antibiotics, and six had residual OM after surgery and received a median of 42 days [42-63]. Three SOTR were medically treated with 42 days of antibiotics alone. Five SOTR (33%) developed re-infection at the same site at a median of 79 days [13-767] after stopping antibiotics (4 recipients from the post-surgical residual OM group and 1 from the medically treated group). Four (27%) SOTR developed a new OM at a different site.

*Conclusions: Clinical features of OM in this cohort were similar to what has been described in the literature for the general population. Despite the combination of immunosuppression and medical comorbidities, the incidence of OM in this cohort was low. However, the rate of re-infection was higher than previously described in non-SOTR. Further studies are needed to determine if a novel approach is warranted in the management of OM in SOTR.

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