title: 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.
authors.affiliation: William J von Liebig Transplant Center, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. ellariza@yahoo.com
authors.forename: E J
authors.initials: EJ
authors.lastname: Ariza-Heredia
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.forename: E A
authors.initials: EA
authors.lastname: Blumberg
authors.forename: R C
authors.initials: RC
authors.lastname: Walker
authors.forename: R
authors.initials: R
authors.lastname: Lewis
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Sankar
authors.forename: M D
authors.initials: MD
authors.lastname: Willliams
authors.forename: J
authors.initials: J
authors.lastname: Rogers
authors.forename: C
authors.initials: C
authors.lastname: Milano
authors.forename: R R
authors.initials: RR
authors.lastname: Razonable
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000378:metabolism; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D016027:Heart Transplantation; D006406:Hematoma / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D016030:Kidney Transplantation; D007710:Klebsiella Infections / Q000188:drug therapy / Q000201:enzymology / Q000382:microbiology / Q000635:transmission*; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification*; D016031:Liver Transplantation; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D019188:Organ Preservation Solutions; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D019188:Organ Preservation Solutions; D001618:beta-Lactamases; C063912:carbapenemase