68 Distinct Microbial Signatures of Healthy and Failing Lung Allografts

Abstract

Purpose: Donor-derived infections (DDIs) are an adverse consequence of solid-organ transplantation. Potential donor-derived transmission events (PDDTEs) reviewed by the OPTN Disease Transmission Advisory Committee (DTAC) were evaluated to determine the impact of DDIs on lung transplant recipients (LTR). Methods and Materials: PDDTEs reviewed by the DTAC from 1/1/20086/30/2011 were evaluated. The cohort included cases with (i) proven or probable transmission (PPT) of infection to a TR of any organ type and (ii) a lung transplant was performed. Organisms and outcomes with and without transmission to LTR are reported. Results: Of 492 donors with PDDTEs during this era, 337 involved infections and 114 included at least 1 LTR. Of the 114, 18 were determined to have a PPT to at least 1 TR. There were 5386 lung transplant donors during the same period. Eleven of 18 (61%) donors had a PPT to the LTR with 10 of 11 having transmission to the LTR only. In 3/10 at least 1 non-LTR received prophylaxis prior to developing infection, and in 1 other the lung was the only organ transplanted. Organisms transmitted to LTR were bacteria (5: TB in 3, MRSA, Serratia), fungi (4: C. immitis, cryptococcus neoformans, aspergillusin 2) and viruses (2: HBV, LCMV). Four of the 11 infected LTR died. Donor lungs were the source of infection in 7 of 8 cases where the donor source was confirmed. No diagnosis of infection in the donor prior to procurement existed. Of the 7 unaffected LTR, 2 received prophylaxis (AFB, C. Immitis) and did not develop an infection and in the remaining 5 disease was transmitted to a non-LTR only. In 1 case the LTR was seropositive for PPT virus pre-transplant. Organisms transmitted to non-LTR were bacteria (1: Pseudomonas), fungi (3: Aspergillus, C. Albicans, C. immitis), and viruses (1: CMV). All non-LTR were alive at least 1 month post-transplant. Conclusions: Donors associated with a PPT in whom a lung is transplanted have a high frequency of infection which can result in death. Continued efforts must be made to identify infected donors prior to recovery in order to prevent the complications of DDIs in LTR.