Mehta Sanjay R, Logan Cathy, Kotton Camille N, Kumar Deepali, Aslam Saima
Division of Infectious Diseases, University of California, San Diego, La Jolla, CA, USA.
Division of Infectious Diseases, San Diego Veterans Affairs Medical Center, San Diego, CA, USA.
Transpl Infect Dis. 2017 Feb;19(1). doi: 10.1111/tid.12645. Epub 2017 Jan 10.
Potential organ donors may be admitted with an infection to an intensive care unit, or contract a nosocomial infection during their stay, increasing the risk of potential transmission to the recipient. Because of a lack of practice guidelines and large-scale data on this topic, we undertook a survey to assess the willingness of transplant infectious diseases (ID) physicians to accept such organs.
We performed a 10-question survey of ID providers from the American Society of Transplantation Infectious Disease Community of Practice to determine the scope of practice regarding acceptance of organs from donors with bloodstream infection, pneumonia, and influenza prior to organ procurement, as well as management of such infections following transplantation.
Among 60 respondents to our survey, a majority indicated that organs would be accepted from donors bacteremic with streptococci (76%) or Enterobacteriaceae (73%) without evidence of drug resistance. Acceptance rates varied based on infecting organism, type of organ, and center size. Ten percent of respondents would accept an organ from a donor bacteremic with a carbapenem-resistant organism. Over 90% of respondents would accept an organ other than a lung from a donor with influenza on treatment, compared with 52% that would accept a lung in the same setting.
This study is the first to our knowledge to survey transplant ID providers regarding acceptance of organs based on specific infections in the donor. These decisions are often based on limited published data and experience. Better characterization of the outcomes from donors with specific types of infection could lead to liberalization of organ acceptance practices across centers.
潜在器官捐献者可能因感染而入住重症监护病房，或在住院期间感染医院获得性感染，从而增加了将感染传播给接受者的风险。由于缺乏关于该主题的实践指南和大规模数据，我们进行了一项调查，以评估移植传染病（ID）医生接受此类器官的意愿。
我们对美国移植传染病实践社区的ID提供者进行了一项包含10个问题的调查，以确定在器官获取前接受来自患有血流感染、肺炎和流感的捐献者的器官的实践范围，以及移植后此类感染的管理。
在我们调查的60名受访者中，大多数人表示会接受来自无耐药证据的感染链球菌（76%）或肠杆菌科（73%）的捐献者的器官。接受率因感染病原体、器官类型和中心规模而异。10%的受访者会接受来自感染碳青霉烯耐药菌的捐献者的器官。超过90%的受访者会接受正在接受治疗的流感捐献者除肺以外的器官，而在相同情况下接受肺的比例为52%。
据我们所知，这项研究是首次针对移植ID提供者就基于捐献者特定感染情况接受器官的问题进行调查。这些决定通常基于有限的已发表数据和经验。更好地描述特定类型感染捐献者的结局可能会导致各中心放宽器官接受标准。
