Donor to Host Transmission of Infection in Lung Transplantation

Purpose To evaluate the incidence and etiology of donor infection and donor to host transmission of infections in lung transplantation. Methods We performed a retrospective cohort study of lung transplant patients at Hospital Italiano de Buenos Aires from January 2010 to March 2017. We analyzed data from electronic medical records. Donor infection was classified as bacteremia, graft colonization or isolated contamination of preservation fluids. Donor-to-host transmission of infection was defined as any infection in the recipient due to at least one microorganism also isolated from the donor and with identical antimicrobial susceptibility pattern. Results We included 55 lung transplant patients. Mean age was 48 years (SD 16), Single lung transplantation was performed in 75% of the cases. Cause of transplantation was chronic obstructive pulmonary disease (n=19), interstitial lung disease (n= 15), cystic fibrosis (n= 16) and others (n=5). Incidence of donor infection was 92.7% (n=51, 95%CI 82-98). Isolated contamination of preservation fluids was determined in 76.4% of cases (n= 42), graft colonization in 83.6% (n= 46) and bacteremia in 12.7% (n=7). The most common microorganisms isolated were gram positive coccus. Incidence of donor to host transmission of infection was 12.7% (n= 7, 95% CI 5-24). All cases were related to graft colonization. 40% (n=3) of recipients that developed infection had inadequate antibiotic prophylaxis. The microbiological etiologies were Acinetobacter baumannii (n=2), Klebsiella pneumoniae (n=2), Citrobacter koseri (n=1), Aspergillus fumigatus (n=1) and Methicillin-Sensitive Staphylococcus Aureus (n=1). Types of host infection were pneumonia (n=5), tracheobronchitis (n=1) and empyema (n=1). Infection-related death occurred in one patient. Conclusion The incidence of donor infection was high but donor to host transmission of infection after lung transplantation was an uncommon event. Inadequate antibiotic prophylaxis was high in those with donor to host transmission of infection. The most frequent etiology for donor infection was gram positive cocci. Gram negative bacteria was the most frequent cause of donor to host transmission of infection.