Impact of pre‐transplant carbapenem‐resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes

Abstract The impact of pre‐transplant (SOT) carbapenem‐resistant Enterobacterales (CRE) colonization or infection on post‐SOT outcomes is unclear. We conducted a multi‐center, international, cohort study of SOT recipients, with microbiologically diagnosed CRE colonization and/or infection pre‐SOT. Sixty adult SOT recipients were included (liver n = 30, hearts n = 17). Klebsiella pneumoniae ( n = 47, 78%) was the most common pre‐SOT CRE species. Median time from CRE detection to SOT was 2.32 months (IQR 0.33–10.13). Post‐SOT CRE infection occurred in 40% ( n = 24/60), at a median of 9 days (IQR 7–17), and most commonly due to K pneumoniae ( n = 20/24, 83%). Of those infected, 62% had a surgical site infection, and 46% had bloodstream infection. Patients with post‐SOT CRE infection more commonly had a liver transplant (16, 67% vs. 14, 39%; p =.0350) or pre‐SOT CRE BSI (11, 46% vs. 7, 19%; p =.03). One‐year post‐SOT survival was 77%, and those with post‐SOT CRE infection had a 50% less chance of survival vs. uninfected (0.86, 95% CI, 0.76–0.97 vs. 0.34, 95% CI 0.08–1.0, p =.0204). Pre‐SOT CRE infection or colonization is not an absolute contraindication to SOT and is more common among abdominal SOT recipients, those with pre‐SOT CRE BSI, and those with early post‐SOT medical and surgical complications.