Nachman Erika J, Ardis Colleen K, B Ardis A Kyle, Nieto Javier, Bresson Madeline M, Robertson Clare M, Seale Maggie N, Villafuerte Nora M, Lyu Zhe, Preisner Eva C, Danhof Heather A, Di Rienzi Sara C, T Becker Yolanda, Britton Robert A
LifeGift, Houston, Texas, USA.
Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA.
Microbiol Spectr. 2025 Aug 5;13(8):e0334124. doi: 10.1128/spectrum.03341-24. Epub 2025 Jun 18.
Approximately 3% of organ transplant recipients will be diagnosed with an invasive fungal infection (IFI), with 10%-47% being fatal. The source of IFI is typically not known, but spp. cause the majority of IFI cases. We obtained intestines from two types of organ donors, brain-dead (BD) ( = 7) and donation after circulatory death (DCD) ( = 5), to sample microbes from the mucosal surface and the lumen. BD donors were parenterally fed and treated with corticosteroids in the days before procurement, whereas DCD donors were enterally fed and not given corticosteroids. We found fungi present in 81% of BD donor samples compared to 31% of DCD donor samples. The fungal load was significantly increased in most of the intestinal sites in BD donor samples over DCD donor samples. We recovered 12 isolates of , 10 isolates of and one isolate of from the human intestine of nine organ donors. Sequence analysis revealed a high prevalence of gene families associated with virulence and drug resistance, the latter of which was corroborated by antifungal resistance testing. Overall, this study provides evidence of increased fungal presence in BD donors compared to DCD donors, which suggests that corticosteroid administration and parenteral feeding strategies of BD donors may impact the burden of IFI in transplant recipients.
Invasive fungal infections pose a significant risk to organ donor recipients, and the sources of these fungal infections are mostly unknown. Our study investigated fungal differences in the gastrointestinal tract between two types of organ donors: brain-dead and donation by circulatory death, for the first time. We found that brain-dead donors had a significant increase in the frequency and abundance of fungi throughout the gastrointestinal tract. We speculate that differences in care, such as corticosteroid administration and feeding methods before organ procurement, may begin to explain the difference in fungal presence between the donors. We propose further studies into the administration of steroids and delivery of nutrients to organ donors before procurement to impact fungal load and reduce life-threatening invasive fungal infections in the recipients.
约3%的器官移植受者会被诊断为侵袭性真菌感染（IFI），其中10% - 47%是致命的。IFI的来源通常不明，但 属真菌导致了大多数IFI病例。我们从两种类型的器官供体获取肠道，脑死亡（BD）供体（n = 7）和循环死亡后捐赠（DCD）供体（n = 5），以从黏膜表面和肠腔采集微生物样本。BD供体在获取器官前几天接受肠外营养并使用皮质类固醇治疗，而DCD供体接受肠内营养且未使用皮质类固醇。我们发现81%的BD供体样本中有真菌，而DCD供体样本中这一比例为31%。与DCD供体样本相比，BD供体样本中大多数肠道部位的真菌负荷显著增加。我们从9名器官供体的人肠道中分离出12株 属真菌、10株 属真菌和1株 属真菌。序列分析显示与毒力和耐药性相关的基因家族具有高流行率，抗真菌耐药性测试证实了后者。总体而言，本研究提供了证据表明与DCD供体相比，BD供体中真菌存在增加，这表明BD供体的皮质类固醇给药和肠外营养策略可能会影响移植受者中IFI的负担。
侵袭性真菌感染对器官移植受者构成重大风险，这些真菌感染的来源大多不明。我们的研究首次调查了两种类型器官供体（脑死亡供体和循环死亡后捐赠供体）胃肠道中的真菌差异。我们发现脑死亡供体整个胃肠道中真菌的频率和丰度显著增加。我们推测，诸如获取器官前的皮质类固醇给药和喂养方法等护理差异，可能开始解释供体之间真菌存在差异的原因。我们建议进一步研究获取器官前对器官供体的类固醇给药和营养输送，以影响真菌负荷并减少受者中危及生命的侵袭性真菌感染。
