1771. Donor-derived Ureaplasma Infection Increases Mortality in Lung Transplant Recipients

Abstract

BackgroundInfection with Ureaplasma species has been linked to fatal hyperammonemia syndrome (HS) in lung transplant (LTx) recipients (R). In this retrospective cohort, we sought to characterize the epidemiology of Ureaplasma spp in both candidates and donors and describe outcomes of antimicrobial therapy in preventing and treating HS.MethodsWe performed a retrospective cohort study of patients who received LTx at Northwestern Memorial Hospital from July 2014 to October 2018. Candidate testing for Ureaplasma spp. was performed with urine culture and PCR testing before LTx but after listing. Positive candidates were treated with levofloxacin for 14 days prior to undergoing LTx. Donor testing was performed with bronchoalveolar lavage (BAL) culture and PCR testing at organ implantation. From July 2014 to February 2017 LTxR were treated according to result; from February 2017 to October 2018 LTxR received empiric levofloxacin and azithromycin at the time of LTx until testing returned negative. HS was defined as new-onset altered mental status (AMS) after LTx with ammonia > 100; if no ammonia was tested, LTxR was classified as not developing HS. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0.Results66 patients who underwent LTx and had candidate screening, donor screening, or both were included. 81.8% (n = 54) of patients had negative screening tests in donor and candidate pre-LTx, 7.5% (n = 5) had positive Ureaplasma spp. testing pre-LTx, and 12.1% (n = 8) had positive donor BAL testing at the time of LTx. One had positive candidate and donor screening (see Table 1). 3 patients developed HS a median of 6 days post-transplant; 2 died with HS as attributed cause. None received empiric therapy. LTxR with confirmed donor-derived infection were more likely to have mortality at 1 year when compared with LTxR with negative testing and candidates with positive testing pre-LTx (P = 0.019). LTxR with donor-derived infection were more likely to have AMS, higher peak ammonia, and require renal replacement therapy, although none reached significance (Table 2).ConclusionDonor-derived Ureaplasma spp. in LTxR was associated with increased mortality at one-year. Pre-transplant screening and treatment had no effect on the outcome. There is high concern for donor transmission and we advocate testing in all LTxR. Disclosures All authors: No reported disclosures.