Outcomes of transplantation using organs from a donor infected with Klebsiella pneumoniae carbapenemase (KPC)‐producing K. pneumoniae

Abstract

Transmission of pathogens from donor to recipient is a potential complication of organ transplantation. Herein, we describe the clinical course and outcomes of 4 transplant recipients who received tissues from a donor with multi-organ infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. Recipient 1 underwent simultaneous liver and kidney transplantation for alpha-1 antitrypsin deficiency and alcohol-related cirrhosis, and acute tubular necrosis, respectively. Soon after transplantation, he developed an infected hematoma and peritonitis due to KPC-producing K. pneumoniae despite receiving tigecycline prophylaxis. He was treated with a prolonged course of tigecycline, amikacin, and meropenem, in conjunction with surgical evacuation and percutaneous drainage of the infected fluid collections. Recipient 2 underwent living-donor liver transplantation for cholangiocarcinoma and primary sclerosing cholangitis using vein graft from the donor infected with KPC-producing K. pneumoniae. Culture of the preservation fluid containing the vein graft was positive for KPC-producing K. pneumoniae. The patient received preemptive amikacin and tigecycline, and he did not develop any infection (as evidenced by negative surveillance blood cultures). The isolates from the donor and Recipients 1 and 2 were indistinguishable by pulsed-field gel electrophoresis. Recipients 3 and 4 underwent kidney and heart transplantation, respectively; both patients received perioperative tigecycline prophylaxis and did not develop infections due to KPC-producing K. pneumoniae. All transplant recipients had good short-term outcomes. These cases highlight the importance of inter-institutional communication and collaboration to ensure the successful management of recipients of organs from donors infected with multidrug-resistant organisms.

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

“…87,88 The update also stressed the importance of inter-facility communication, 89 which was shown to be a critical component of successful management of organ transplant recipients from a donor infected with CRKP. 43 Following the 2 recent CRE outbreaks related to contaminated duodenoscopes in the United States and during which one kidney-pancreas transplant recipient died, 90,91 the CDC has also provided guidance on surveillance for bacterial contamination of duodenoscopes after reprocessing. 92 In one outbreak, ethylene oxide sterilization of duodenoscopes halted CRE transmission.…”

“…The recipient's CRKP isolate was phenotypically identical to that of the donor, and he was successfully treated. 43 In the second case, the donor sputum and bronchoalveolar lavage cultures were noted to grow CRKP 2 d following procurement. Recipients of the donor's liver and kidneys did not receive any CRKP-targeted prophylaxis, but the lung transplant recipients received 5 d of parenteral colistin.…”

Cross-Infection of Solid Organ Transplant Recipients by a Multidrug-Resistant Klebsiella pneumoniae Isolate Producing the OXA-48 Carbapenemase, Likely Derived from a Multiorgan Donor

“…Concerning the second point, it has been suggested that organs from donors colonized with CPE may be considered for transplantation under well-defined conditions (18,19). However, the risk of cross-infections in these cases appears to be high, and the potential consequences should be carefully considered.…”

“…These infections are typically caused by pathogens acquired from the hospital environment or already present as colonizers in the transplant recipient (14,17,18). However, cross-transmission of MDR bacteria is also possible from donors infected or colonized by MDR bacteria.…”

“…In fact, few reports have dealt with cross-transmission of CPE from organ donors to transplant recipients (18)(19)(20), but the risk of similar events is expected to increase following the ongoing global spread of CPE (12,13). The hypothesis that the infections that occurred in the two transplant recipients were derived from cross-transmission of the K. pneumoniae strain via the transplanted organs is strongly supported by the timing of the infections, by the identity of the K. pneumoniae isolates, including that found in the kidney perfusion fluid, and by the fact that OXA-48-producing K. pneumoniae isolates were very uncommon in Italy at the time of the infections (mid-2011) (21).…”