Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:51pm-4:03pm
*Purpose: Although there is concern about the use of donor organs that are infected or colonized with multidrug-resistant organisms (MDROs), their impact on solid organ transplant recipient (SOTR) outcomes remains unknown. In this study, we evaluated the association between donor MDROs and risk of SOTR infection post-transplant.
*Methods: A retrospective cohort study was conducted at three transplant centers in Philadelphia between 1/1/2015-6/30/2016. All SOTR who underwent transplantation with a local deceased organ donor were included. Exposed SOTRs were categorized into two groups: those whose donor had (1) at least one MDRO on culture, and (2) at least one non-MDRO bacterial or candidal organism on culture. SOTRs were considered unexposed if their donor had no positive cultures. MDROs included methicillin-resistant S. aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase or carbapenem-resistant Enterobacterales, multidrug-resistant (MDR) P. aeruginosa, or MDR Acinetobacter species. The primary outcome was any bacterial or invasive candidal infection within three months post-transplant as determined by manual chart review. Donor-derived infections (DDIs) were secondarily evaluated; DDIs were defined as a bacterial or candidal infection within three months post-transplant with the same organism and same susceptibility profile as was present on donor culture. A mixed-effects multivariable frailty model was developed to determine the association between donor culture results and time to first infection (DDI or non-DDI), with a random effect for donor.
*Results: Of 658 total SOTR, 93 (14%) had donors with at least one MDRO on culture, 477 (73%) had donors with at least one non-MDRO positive culture, and 88 (13%) had donors with no positive cultures. On multivariable analysis, donor MDROs were associated with a significantly increased hazard of infection post-transplant (aHR 1.75, 95% CI 1.07-2.87, P=0.03) while non-MDRO positive donor cultures were not (aHR 1.45, 95% CI 0.97-2.16, P=0.07). The association between donor MDROs and SOTR infection was attenuated after removing DDIs from the outcome (aHR 1.64, 95% CI 0.97-2.78, P=0.06), suggesting that DDIs were an important driver of this association.
*Conclusions: SOTR whose donors carry MDROs are at increased risk for early post-transplant bacterial or invasive candidal infection, which is primarily related to increased rates of DDIs. Further studies evaluating methods for reducing this risk are needed.
To cite this abstract in AMA style:Anesi JA, Blumberg EA, Han JH, Lee DH, Clauss H, Hasz R, Molnar E, Alimenti D, Motzer AR, West S, Bilker WB, Tolomeo P, Lautenbach E, Program TPreventionEpicenters. Impact of Donor Multidrug-Resistant Organisms on Risk of Recipient Infection [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-donor-multidrug-resistant-organisms-on-risk-of-recipient-infection/. Accessed December 5, 2020.
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