title: Fatal pneumonia caused by Panton-Valentine Leucocidine-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA) transmitted from a healthy donor in living-donor liver transplantation.
abstract: Severe infections are the most dangerous complications in liver transplantation and their prevention is one of the major goals. A 60-year-old Saudi-Arabian female with decompensated hepatitis C liver cirrhosis received a right-lobe liver graft from her healthy daughter. After 9 days, the patient developed a rapidly progressive necrotizing pneumonia that was fatal in spite of extracorporal lung assist. The pneumonia was due to a Panton-Valentine Leucocidine-positive (PVL) methicillin-resistant Staphylococcus aureus (MRSA), or "community-acquired" MRSA, that had not been detectable in the patient preoperatively. The same strain of PVL-MRSA could be demonstrated in the nares of the asymptomatic donor, but not of other relatives, patients, or medical staff. These findings strongly suggest transmission of PVL-MRSA from the donor to the recipient. This case demonstrates a previously unknown, and potentially fatal, risk in living-donor liver transplantation: transmission of a severe infection from a healthy donor to the recipient.
authors.affiliation: Klinik und Poliklinik für Chirurgie, Universität Regensburg, Regensburg, Germany.
authors.forename: Aiman
authors.initials: A
authors.lastname: Obed
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Schnitzbauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Bein
authors.forename: Norbert
authors.initials: N
authors.lastname: Lehn
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Linde
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
mesh_terms: D000328:Adult; D005260:Female; D006262:Health; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D016106:Methicillin Resistance; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000635:transmission*; D011859:Radiography; D013211:Staphylococcus aureus / Q000502:physiology*; D017211:Treatment Failure