Study outlines risk of infection for donor kidneys

A study on deceased donor kidneys has identified hepatitis C viremia, the need for dialysis, hematopoietic cell transplant and exposure to antibiotics with a narrow gramnegative spectrum as the top risks for infection.

“One of the most significant issues facing solid organ transplantation (SOT) is the limited supply of organ donors. Deceased donors with positive bacterial cultures have been utilized inconsistently in the past due to prior reports of SOT donors transmitting bacteria to their organ recipients via the allograft, causing donorderived bacterial infections (DDBIs),” wrote Judith A. Anesi, MD, and colleagues. “DDBIs have been linked to poor outcomes including vascular anastomosis dehiscence, overwhelming infection and death.”

An organ donor who carries a multidrugresistant organism (MDRO), the researchers wrote, carries the greatest risk of transferring an infection to the recipient because a DDBI due to an MDRO may be more difficult to treat. Current national transplant guidelines recommend caution when considering the use of organs that may carry an MDRO.

“Though risk factors for MDROs in the general population have been well studied, there are no published studies to our knowledge that have determined risk factors associated with MDROs among deceased organ donors specifically,” the authors wrote.

The profile of deceased donors lends itself to a high risk for MDROs, the authors wrote. Many are admitted to an ICU during their terminal hospitalization — a common site where MDRO colonization can take place.

“Deceased organ donors are typically younger, with fewer medical comorbidities, increased rates of injection drug use (IDU) and increased rates of traumatic injuries compared to the general population receiving ICU care,” the authors wrote. “In addition, the clinical data available to transplant centers about the organ donor is more limited than that available to clinicians when caring for a hospitalized patient directly.”

The researchers conducted a retrospective cohort study at four transplant centers between 2015 and 2016. All deceased donors who donated at least one organ were included. Cultures obtained during the donor's terminal hospitalization and organ procurement were evaluated. Multivariable Cox regression helped to determine risk factors associated with time to donor MDRO.

Of 440 total donors, 15% grew an MDRO on culture. Hepatitis C viremia, a patient’s need for dialysis, prior hematopoietic cell transplant and exposure to antibiotics with a narrow gramnegative spectrum provided the highest risk.

“This is the first study to determine risk factors for MDROs among deceased donors and will be important for risk stratifying potential donors and informing transplant recipient prophylaxis,” the authors wrote.- by Mark E. Neumann

Disclosures: Blumberg receives research support from Shire and Merck, is a member of the data and safety monitoring boards for BristolMyers Squibb and GlaxoSmithKline and is also a member of the scientific advisory committee for Merck. The other authors report no relevant financial disclosures.

A study on deceased donor kidneys has identified hepatitis C viremia, the need for dialysis, hematopoietic cell transplant and exposure to antibiotics with a narrow gramnegative spectrum as the top risks for infection.

“One of the most significant issues facing solid organ transplantation (SOT) is the limited supply of organ donors. Deceased donors with positive bacterial cultures have been utilized inconsistently in the past due to prior reports of SOT donors transmitting bacteria to their organ recipients via the allograft, causing donorderived bacterial infections (DDBIs),” wrote Judith A. Anesi, MD, and colleagues. “DDBIs have been linked to poor outcomes including vascular anastomosis dehiscence, overwhelming infection and death.”

An organ donor who carries a multidrugresistant organism (MDRO), the researchers wrote, carries the greatest risk of transferring an infection to the recipient because a DDBI due to an MDRO may be more difficult to treat. Current national transplant guidelines recommend caution when considering the use of organs that may carry an MDRO.

“Though risk factors for MDROs in the general population have been well studied, there are no published studies to our knowledge that have determined risk factors associated with MDROs among deceased organ donors specifically,” the authors wrote.

The profile of deceased donors lends itself to a high risk for MDROs, the authors wrote. Many are admitted to an ICU during their terminal hospitalization — a common site where MDRO colonization can take place.

“Deceased organ donors are typically younger, with fewer medical comorbidities, increased rates of injection drug use (IDU) and increased rates of traumatic injuries compared to the general population receiving ICU care,” the authors wrote. “In addition, the clinical data available to transplant centers about the organ donor is more limited than that available to clinicians when caring for a hospitalized patient directly.”

The researchers conducted a retrospective cohort study at four transplant centers between 2015 and 2016. All deceased donors who donated at least one organ were included. Cultures obtained during the donor's terminal hospitalization and organ procurement were evaluated. Multivariable Cox regression helped to determine risk factors associated with time to donor MDRO.

Of 440 total donors, 15% grew an MDRO on culture. Hepatitis C viremia, a patient’s need for dialysis, prior hematopoietic cell transplant and exposure to antibiotics with a narrow gramnegative spectrum provided the highest risk.

“This is the first study to determine risk factors for MDROs among deceased donors and will be important for risk stratifying potential donors and informing transplant recipient prophylaxis,” the authors wrote.- by Mark E. Neumann

Disclosures: Blumberg receives research support from Shire and Merck, is a member of the data and safety monitoring boards for BristolMyers Squibb and GlaxoSmithKline and is also a member of the scientific advisory committee for Merck. The other authors report no relevant financial disclosures.