Status:
Ready to upload
Record number:
1818
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
No previous information about potential donor transmission of Actinomyces israelii.
Time to detection:
No donor-derived transmission was detected in the recipients of the transplanted grafts (heart, liver, kidneys and corneas)
Alerting signals, symptoms, evidence of occurrence:
If donor transmission were to occur, would expect abscesses including sinopulmonary disease, brain abscesses, visceral organ abscesses including lung, liver and spleen. The primary message of this paper is that appropriate antimicrobial therapy in the donor, received for a minimum of 24-48 hours can prevent transmission via the allograft organs. The one potential concern is to ensure the absence of visceral disease, specifically liver disease, to avoid transplantation of an actively infected organ with an undrained abscess. Of note, this patient underwent a thoracic and abdominal CT pre-procurement with no evidence of intra-abdominal/visceral abscesses.
Demonstration of imputability or root cause:
There was no evidence of donor-transmitted infection within a 6-month follow-up period.
Groups audience:
Keywords:
References:
Suggest new keywords:
actinomyces israelii, meningitis
Reference attachment:
Suggest references:
Successful multiple organ donation after donor brain death due to Actinomyces israelii meningitis. Lagunes, et al. Transpl Infect Dis. 2017 Apr 21.
Note:
While there was no evidence of donor transmission, this is an important paper to be made available to the transplant community, particularly involving Actinomyces, as opposed to common pathogens such as Streptococcus pneumonia, where there has been literature to show the ability to accept organs from donors who received 24-48 hours of antimicrobial therapy. There have been no previous papers indicating donor transmission of Actinomyces.
second Review Carl-Ludwig: we must be careful in Evaluation of donors and Management of infection. The Approach of the Team deserves appreciation regarding communication of best practice.
Expert comments for publication:
This is an important paper to indicate the ability to accept organs from donors with Actinomyces meningitis after 24-48 hours of antibiotic therapy and thorough evaluation (such as a CT scan of the chest, abdomen and pelvis) to rule out visceral disease. Infections without systemic spread such as acute meningitis are not an absolute contraindication for transplantation if the cause has been identified, appropriate antimicrobial therapy is administered to donors for a minimum of 48 hours or more and infection is clinically controlled.