Outcomes of Lung Transplantation From Donors With Positive Blood Cultures

Abstract

SESSION TITLE: Outcomes in Lung Transplantation Slide SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM PURPOSE: The pool of lung transplant donors remains small despite development of extended donor criterion for lung transplantation. Bacteremia poses a major concern as organisms can be transmitted to immunocompromised allograft recipients leading to risk of septic shock and death. Other solid organ transplants have safely transplanted allografts despite bacteremic donors (BD). With several case series hinting this may be true in lung transplantation, we analyzed national registry data to evaluate any association between BD and lung transplant recipient outcomes. METHODS: We utilized the United Network for Organ Sharing registry to identify first-time adult lung transplants performed since LAS implementation in 05/2005-06/2015. Patient survival was compared between recipients of organs from BD and patients receiving organs from non-bacteremic donors (NBD) using proportional hazard models. RESULTS: Of 15,983 lung transplants performed, 1,050 (7%) involved BD. Univariate Cox analysis found no difference in patient survival (HR=1.01; 95% CI: 0.91, 1.12; p=0.89) associated with positive blood cultures. Multivariable model fitted to 15,798 patients with complete data, adjusting for recipient and donor gender, recipient and donor race, recipient age, diagnosis, ECMO and mechanical ventilation at transplantation, transplant type, final LAS, BMI, Cr, and transplant year, also found no significant differences in survival associated with BD (HR=0.99; 95% CI: 0.89, 1.10; p=0.89). Analysis stratified by diagnosis, steroid use, and immunosuppression found no associations between BD and patient survival in any of the subgroups. Interactions between donor positive blood cultures and continuous covariates including age and LAS showed no effects either. CONCLUSIONS: Analysis of national registry data confirmed similar survival regardless of donor blood cultures being positive or negative after lung transplantation. BD can be carefully considered for lung transplantation with similar survival outcomes as compared to NBD. CLINICAL IMPLICATIONS: Donors with positive blood cultures can be added to the pool of potential donors for lung transplantation. DISCLOSURE: The following authors have nothing to disclose: Sadia Shah, Tumin Dmitry, Amy Pope-Harman, Brian Keller, Stephen Kirkby, Peter Lee, Stephanie Pouch, Bryan Whitson No Product/Research Disclosure Information