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Original Articles: Adult Cardiac

Intrathoracic Organ Transplantation From Donors With Meningitis: A Single-Center 20-Year Experience

Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals NHS Trust, London, United Kingdom

Accepted for publication July 16, 2008.

^_* Address correspondence to Mr Bahrami, Department of Cardiothoracic Surgery, Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Trust Harefield, Middlesex, UB9 6JH, United Kingdom (Email: t.bahrami2{at}rbht.nhs.uk).

Background: Availability of cadaveric organs continues to be the key factor limiting the number of transplants performed. Donor with bacterial meningitis is often considered to be controversial for organ retrieval. The purpose of this retrospective study was to review the long-term outcome of orthotopic heart and lung transplantation at our institution, from donors who died as a result of meningitis.

Methods: Between July 1986 and July 2006, 39 adult patients who underwent heart and lung transplantation performed with organs from cadaveric donors with bacterial meningitis were retrospectively studied. Donors and recipients were identified by a prospectively kept database. Bacterial meningitis was identified either with positive blood or cerebrospinal fluid culture and positive signs and symptoms. All patients had one or more of these criteria. There were 15 heart, 12 lung (4 bilateral), and 12 heart-lung transplants.

Results: All donors had identified pathogens: Neisseria meningitidis (n = 21; 53.8%), Streptococcus pneumoniae (n = 16; 41%), and Haemophilus influenzae (n = 2; 5.2%). Adequate antimicrobial therapy before organ retrieval and after transplant was administered. The hospital mortality was 10.2% (n = 4). There were no infectious complications caused by meningeal pathogens. Other causes of hospital mortality were rejection (n = 2), intracranial bleeding (n = 1), and staphylococcus sepsis (n = 1). The mean posttransplant follow-up was 5.35 ± 5.54 years (range, 1 month to 18.9 years).

Conclusions: Intrathoracic organ transplantation using donors with bacterial meningitis is an acceptable strategy. No organism (Neisseria meningitides, Streptococcus pneumoniae, and Haemophilus influenzae) could be identified as contraindication because no recipient died of infectious-related diseases.