Infection with Ureaplasma spp in Lung Transplant Recipients is Donor-Derived

• Published in: The Journal of heart and lung transplantation Vol. 39; no. 4; p. S47
• Main Authors: Roberts, S.C., Bharat, A., Kurihara, C., Ison, M.G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2020
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2020.01.1220

Recent studies using human subjects and murine models have demonstrated a causal link infection with Ureaplasma spp in lung transplant (LTx) recipients (R) and hyperammonemia syndrome (HS). We sought to determine the source of Ureaplasma as well as the risk factors associated with the development of HS.
Consecutive patients who underwent LTxR at Northwestern Memorial Hospital from 7/2014 - 10/2018 and had Ureaplasma testing were included. Donor testing for Ureaplasma spp was performed through bronchoalveolar lavage (BAL) at the time of implantation. From 7/2014 - 2/2017 LTxR were treated only if found positive; from 2/2017 - 1/2018 all LTxR received empiric levofloxacin and azithromycin until negative testing. Donor were evaluated through DonorNet®.
Sixty-six patients who underwent LTxR with screening were included. Ureaplasma spp was detected on BAL PCR in 12.1% (n=8) of donors. 87.8% (n=58) of donors tested negative. Positive donors were younger (26.6 vs 39.2 years, p = 0.014) and sexually active (100% vs 65.5%, p = 0.047). Donors were more likely to be male (87.5% vs 63.8%, p = 0.182). All LTxR who developed HS (n=3) were positive for Ureaplasma spp on donor BAL PCR and were not empirically treated prior to microbial confirmation. Five patients were BAL PCR positive but did not develop HS but antimicrobial therapy was initiated empirically either in the donor prior to or recipient at transplantation.
Infection with Ureaplasma spp in LTxR appears donor-derived. Positive donors were younger sexually active males. Empiric therapy prevents HS and screening should be performed in all LTxR.