PGY2 Solid Organ Transplant Pharmacy Residency

Impact of Positive Donor Cultures on Postoperative Lung Transplantation Infectious Outcomes

Anna Curtis, PharmD; Christine Pham, PharmD; Brett J. Pierce, PharmD, BCPS; Duc Nguyen, MD, PhD; Edward Graviss, PhD, MPH

PURPOSE

Transmission risk of microbes present in donor lungs at time of donation to lung transplant recipients (LTR) is unclear. Infection is the second highest cause of 30-day (d) mortality. Guidelines for donor-derived infections recommend 7-14d of antibiotics in recipients of bacteremic donors. There is limited data assessing transmission of non-blood donor infections and outcomes post-lung transplantation. We sought to describe infectious outcomes within 90 days after lung transplant in patients with positive donor cultures.

METHODS

This was a single-center, retrospective, descriptive study. We reviewed LTR from 2016-2020 with positive donor cultures from any site. Patients were excluded if they had cystic fibrosis, a multiorgan or redo transplant, or active infection at time of transplant. Protocol post-op antibiotics included vancomycin and cefepime x7d with extension to 14d if positive donor cultures were reported. Our primary outcome was the incidence of infectious outcomes, defined as Clostridioides difficile (C. diff) and multi-drug resistant organisms (MDRO), within 90d post-lung transplantation. Secondary outcomes included transmission characterization, antibiotic regimens, and 90-day mortality.

RESULTS Of 83 included patients, C. diff occurred in 11% (n=9) and MDRO occurred in 25% (n=21) of LTR within 90d. Donor cultures were 96% bacterial and 94% from lungs/sputum. Immediate organism clearance (organism identified in donor but not in LTR cultures) occurred in 83% of LTR (n=69). All donor-derived organisms were respiratory infections (RI) in the 14 LTRs that grew through post-op antibiotics. Median duration of post-op antibiotics was 14d (IQR 11-18) in these positive RI LTR vs 11d (IQR 9-15) in those who demonstrated immediate clearance. Positive RI LTR demonstrated organism clearance after a median of 4d (IQR 3-6).

CONCLUSION

While incidence of C. diff and MDRO was low and did not appear to correlate with antibiotic duration, LTR may benefit from decreased antibiotics duration given immediate clearance occurred in 83% of LTR. Our study suggests antibiotics past 7d may not be necessary in lung transplant patients with gram-positive respiratory cultures or with non-respiratory and/or non-bacteremic donor cultures.

PGY2 SOLID ORGAN TRANSPLANT PHARMACY RESIDENCY

Anna E Curtis, PharmD

Anna earned her PharmD from the University of Houston College of Pharmacy in 2019. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 residency, Anna has accepted a position as an Abdominal Transplant Pharmacist at Medical City Fort Worth. Primary project preceptor: Christine Pham, PharmD

Presented at 2020 Virtual Vizient Pharmacy Network Conference, 2021 Virtual Midwest Pharmacy Residents Conference, and 2021 Virtual American Transplant Congress

Intravenous immunoglobulin in heart transplant recipients with mild to moderate hypogammaglobulinemia and infection

Johnny Hoang, PharmD; Mozhgon Moaddab, PharmD, BCPS; Duc T Nguyen, MD, PhD; Edward A Graviss, PhD, MPH; Ashrith Guha, MD, MPH; Jill Krisl, PharmD, BCPS

PURPOSE Hypogammaglobulinemia (HGG) is a complication of solid organ transplantation associated with an increased infection risk. Intravenous immunoglobulin G (IVIG) replacement in patients with HGG may be able to reduce rates of infection; however, few studies have assessed the use of IVIG in mild to moderate HGG (IgG 400-700 mg/dL) and heart transplant recipients with simultaneous infection.

RESULTS

Forty-two patients were included in this study. Patients in the IVIG group received on average one dose of IVIG at 0.5 g/kg. No differences in incidence of new infection at 3 months (26.3% vs 17.4%; p=0.71) and 6 months (42.1% vs 34.8%; p=0.63) were observed between the IVIG and non-IVIG groups. Infections based on mild or moderate HGG also had no differences. Severity of HGG was not associated with new infections at 3 and 6 months.

METHODS

A single center, retrospective study was performed assessing heart transplant recipients admitted between October 2017 to May 2020 with a documented infection and mild (IgG 500-700 mg/dL) to moderate (IgG 400-499 mg/dL) HGG.

CONCLUSION

Our findings suggest that IVIG in mild to moderate HGG may have little to no benefit in reducing incidence of new infections. Larger prospective studies are needed to confirm these findings.

PGY2 SOLID ORGAN TRANSPLANT PHARMACY RESIDENCY

Johnny Hoang, PharmD

Johnny earned his PharmD from the University of Houston College of Pharmacy in 2019. He completed his PGY1 residency at Houston Methodist Hospital. Following completion of his PGY2, Johnny will work as an advanced clinical pharmacist in solid organ transplant at Medical City Dallas. Primary project preceptor: Jill Krisl, PharmD, BCPS

Presented at 2020 Virtual Vizient Pharmacy Network, 2021 Virtual Midwest Pharmacy Residency Conference, and 2021 Virtual American Transplant Congress