and Donor-Derived Infection and Hyperammonemia Syndrome in 4 Solid Organ Transplant Recipients From a Single Donor.

Hyperammonemia syndrome (HS) is a life-threatening condition occurring in solid organ transplant patients, affecting primarily lung recipients, and is associated with and/or spp infection. The organ donor was a young man who died of hypoxic brain injury and had urethral discharge antemortem. The donor and 4 solid organ transplant recipients had infection with and/or spp. The lung and heart recipients both developed altered conscious state and HS associated with and spp infections. Despite treatment with antibiotics and ammonia scavengers, both the lung and heart recipients died at day +102 and day +254, respectively. After diagnosis in the thoracic recipients, screening samples from the liver recipient and 1 kidney recipient were culture positive for with or without spp. Neither the liver nor kidney recipients developed HS. Our case series demonstrates the unique finding of and spp dissemination from an immunocompetent donor across 4 different organ recipients. Phylogenetic whole genome sequencing analysis demonstrated that samples from recipients and donor were closely related, suggesting donor-derived infection. Screening of lung donors and/or recipients for and spp is recommended, as well as prompt treatment with antimicrobials to prevent morbidity.