1993. Donor-Derived Transmission of Candida species: 10-year Analysis from the OPTN ad hoc Disease Transmission Advisory Committee (DTAC)

Abstract Background Solid organ transplantation (SOT) is lifesaving, but donor-derived infections can be associated with significant morbidity and mortality. Candida species are common colonizers in deceased donors managed in the intensive care environment, and transmission to the recipient through transplantation is a described phenomenon. We sought to characterize Candida transmission events in the US SOT population. Methods Cases referred to Organ Procurement and Transplantation Network (OPTN) Disease Transmission Advisory Committee (DTAC) between 2012 and 2022 as potential donor disease transmission events (PDDTE) were adjudicated by DTAC based on consensus definitions. We included all recipients from any donor in which ≥1 proven or probable (P/P) or possible transmission of Candida occurred. Results Forty deceased donors were identified (characteristics, Table 1). 124 SOT recipients received organs from these donors including 60 kidney, 27 liver, 15 heart, 14 lung, and 8 multivisceral or other. DTAC adjudications of recipients included 8 proven, 16 probable, 24 possible, 1 unlikely, 51 excluded, and 24 intervention without disease transmission (IWDT). Growth of Candida in culture occurred in 24 of 40 donors and 63 of 124 recipients. Recipients were frequently bacteremic and had Candida growth at site of explanted kidney (Table 2). Mycotic aneurysm, bleed or hematoma occurred in 22 SOT recipients, 10 of which were P/P. Allograft explant was performed in 14 recipients (13 kidney and 1 other), 7 of which were P/P. Within 45 days of PDDTE reports, death occurred in 17 SOT recipients (1 proven, 7 possible, 7 excluded, 1 unlikely, 1 unknown). Only 6 of the 17 recipients who died received antifungal therapy. Seven deaths occurred in the 49 mate recipients of the 24 P/P transmissions, though lack of culture results did not support escalating adjudications beyond possible. Conclusion Donor-derived Candida infections occur with significant associated morbidity, including graft loss, and mortality, especially in kidney recipients. Opportunity exists to further identify risks, improve communication across transplant centers, initiate appropriate antifungal therapy, and improve management of mycotic aneurysm due to candidiasis. Disclosures Jason D. Goldman, MD, MPH, Adaptive Biotechnologies: Collaborative services agreements|Eli Lilly: Advisor/Consultant|Eli Lilly: Grant/Research Support|Eli Lilly: Honoraria|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Gra