Predictors of Multidrug-Resistant Organisms among Solid Organ Transplant Donors
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: 237
Keywords: Bacterial infection, Donors, marginal, Multivariate analysis
Session Information
Date: Monday, June 3, 2019
Session Name: Concurrent Session: Infectious Epidemiology
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 304
*Purpose: Transplant guidelines recommend exercising caution when considering donor organs that may be infected or colonized with multidrug-resistant organisms (MDROs). Approaches to identifying such potentially higher risk organs are unknown. We identified predictors of MDROs among organ donors based on information available at the time of organ procurement.
*Methods: A case-control 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. Cases were donors with ≥1 MDRO on culture, including methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, extended-spectrum beta-lactamase (ESBL) or carbapenem-resistant Enterobacteriaceae, multidrug-resistant (MDR) P. aeruginosa, or MDR Acinetobacter species. Controls were donors with no MDRO-positive cultures. Cultures obtained during the terminal hospitalization and at the time of organ procurement were considered. Multivariable logistic regression was used to determine risk factors for MDRO-positive donors.
*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%). On multivariable analysis, the predictors of an MDRO on donor culture included: a detectable hepatitis C (HCV) viral load (odds ratio [OR] 4.34, 95% confidence interval [CI] 1.61-11.71, P<0.01) and longer terminal hospitalization (OR 1.04, 95% CI 1.01-1.08, P=0.01). There was a trend towards significance with donor marijuana use (OR 2.05, 95% CI 0.96-4.34, P=0.06), donor dialysis (OR 5.21, 95% CI 0.87-31.40, P=0.07), and female gender (OR 1.75, 95% CI 1.00-3.08, P=0.05).
*Conclusions: There was a moderate rate of MDRO growth on donor cultures, with risk factors including a prolonged terminal hospitalization and HCV viremia, which may be a proxy for intravenous drug use. Donors on dialysis and those that use marijuana may also have an increased risk for MDROs. This information is routinely provided to recipient centers and could be used to help inform risk stratification of donors.
To cite this abstract in AMA style:
Anesi JA, Blumberg EA, Han JH, Lee DH, Clauss H, Climaco A, Hasz R, Molnar E, Alimenti D, West S, Bilker W, Tolomeo P, Lautenbach E. Predictors of Multidrug-Resistant Organisms among Solid Organ Transplant Donors [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/predictors-of-multidrug-resistant-organisms-among-solid-organ-transplant-donors/. Accessed November 25, 2020.« Back to 2019 American Transplant Congress