Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Donor-derived infections (DDIs) among solid organ transplant recipients (SOTR) are often associated with significant morbidity and mortality, although the predisposing factors for DDIs remain unknown. In this study, we determined risk factors for bacterial and candidal DDIs.
*Methods: A case-control study was conducted at three transplant centers in Philadelphia between 1/1/2015 and 6/30/2016. All SOTR who underwent transplantation with a local deceased organ donor who had at least one bacterial or candidal organism grow on donor culture were included. Cases were those SOTR that developed a probable DDI (adjudicated by three infectious diseases physicians and defined as a recipient bacterial or candidal infection within three months post-transplant with the same organism and same susceptibility profile as was present on donor culture). Controls were those who did not develop a DDI (including those with no infections or non-DDI infections post-transplant). Multivariable logistic regression was performed to determine the risk factors associated with DDI, including both donor and recipient factors.
*Results: Of 570 SOTR whose donors had at least one positive culture, 31 (5%) developed a DDI. The most common organisms causing DDIs were Staphylococcus aureus (17, 53%) and Klebsiella species (5, 16%). On multivariable analysis, the independent risk factors for DDI included: lung transplantation (OR 23.59, 95% CI 7.03-79.24, P<0.01), donors on chronic immunomodulators (OR 10.51, 95% CI 2.52-43.84, P<0.01), date of transplant (OR 0.995 per day forward in time, 95% CI 0.992-0.998, P<0.01), donors with positive genitourinary (GU) cultures (i.e. urine or ureter cultures) (OR 4.43, 95% CI 1.64-11.94, P<0.01), and donors with Klebsiella spp on culture from any anatomical site (OR 5.51, 95% CI 1.94-15.67, P<0.01). Finally, GU cultures were a particularly significant risk factor when restricted to those with a multidrug-resistant organism (OR 16.70, 95% CI 2.27-122.89, P=0.01).
*Conclusions: This is the first analysis to determine independent risk factors for DDIs among a complete cohort of SOTRs from a single organ procurement organization. Our study suggests that both donor and recipient factors, as well as specifics of the donor infection, are important in mediating this outcome. Further study is needed to determine effective methods for preventing DDIs.
To cite this abstract in AMA style:Anesi JA, Lautenbach E, Han JH, Lee DH, Clauss H, Hasz R, Molnar E, Alimenti D, Motzer AR, West S, Bilker WB, Tolomeo P, Blumberg EA, Program TPreventionEpicenters. Risk Factors for Bacterial or Candidal Donor-Derived Infections among Solid Organ Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-bacterial-or-candidal-donor-derived-infections-among-solid-organ-transplant-recipients/. Accessed December 2, 2020.
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