Watkins A C, Vedula G V, Horan J, Dellicarpini K, Pak S-W, Daly T, Samstein B, Kato T, Emond J C, Guarrera J V
Division of Abdominal Organ Transplantation, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
Transpl Infect Dis. 2012 Jun;14(3):311-5. doi: 10.1111/j.1399-3062.2011.00712.x. Epub 2012 Jan 29.
In solid organ transplantation, the disparity between donor supply and patients awaiting transplant continues to increase. The organ shortage has led to relaxation of historic contraindications to organ donation. A large percentage of deceased organ donors have been subjected to traumatic injuries, which can often result in intervention that leads to abdominal packing and intensive care unit resuscitation. The donor with this "open abdomen" (OA) presents a situation in which the risk of organ utilization is difficult to quantify. There exists a concern for the potential of a higher risk for both bacterial and fungal infections, including multidrug-resistant (MDR) pathogens because of the prevalence of antibiotic use and critical illness in this population. No recommendations have been established for utilization of organs from these OA donors, because data are limited. Herein, we report a case of a 21-year-old donor who had sustained a gunshot wound to his abdomen, resulting in a damage-control laparotomy and abdominal packing. The donor subsequently suffered brain death, and the family consented to organ donation. A multiorgan procurement was performed with respective transplantation of the procured organs (heart, liver, and both kidneys) into 4 separate recipients. Peritoneal swab cultures performed at the time of organ recovery grew out MDR Pseudomonas aeruginosa on the day after procurement, subsequently followed by positive blood and sputum cultures as well. All 4 transplant recipients subsequently developed infections with MDR P. aeruginosa, which appeared to be donor-derived with similar resistance patterns. Appropriate antibiotic coverage was initiated in all of the patients. Although 2 of the recipients died, mortality did not appear to be clearly associated with the donor-derived infections. This case illustrates the potential infectious risk associated with organs from donors with an OA, and suggests that aggressive surveillance for occult infections should be pursued.
在实体器官移植中，供体器官供应与等待移植患者之间的差距持续扩大。器官短缺导致了对器官捐赠历史禁忌的放宽。很大比例的已故器官供体遭受过创伤性损伤，这往往会导致进行腹部填塞和重症监护病房复苏等干预措施。这种“开放性腹部”（OA）的供体情况使得器官利用风险难以量化。由于该人群中抗生素的广泛使用和危重病的流行，人们担心细菌和真菌感染的风险更高，包括多重耐药（MDR）病原体。由于数据有限，尚未针对这些OA供体的器官利用制定相关建议。在此，我们报告一例21岁的供体，其腹部遭受枪伤，导致实施损伤控制剖腹术和腹部填塞。该供体随后发生脑死亡，其家属同意器官捐赠。进行了多器官获取，并将获取的器官（心脏、肝脏和双肾）分别移植给4名不同的受者。器官获取时进行的腹膜拭子培养在获取后第二天培养出多重耐药铜绿假单胞菌，随后血培养和痰培养也呈阳性。所有4名移植受者随后均发生了多重耐药铜绿假单胞菌感染，这些感染似乎源自供体且耐药模式相似。所有患者均开始使用适当的抗生素进行治疗。尽管有2名受者死亡，但死亡率似乎与供体来源的感染并无明显关联。该病例说明了与OA供体器官相关的潜在感染风险，并表明应积极监测隐匿性感染。
