Transmission of multidrug-resistant Escherichia coli through kidney transplantation --- California and Texas, 2009

On July 6, 2009, the Organ Procurement and Transplantation Network received notification of possible disease transmission. A transplant center in California (TCA) reported a kidney transplant recipient with Escherichia coli urinary tract infection and sepsis suspected to have been contracted from the donated kidney. Upon further investigation, a transplant center in Texas (TCB) reported that the recipient of the other kidney from the same donor developed a perinephric abscess caused by E. coli. The kidney grafts failed in both recipients; however, both recipients survived. E. coli isolates from both recipients demonstrated similar antimicrobial susceptibility profiles. Molecular typing studies conducted at CDC showed that the E. coli isolates from both kidney recipients were identical to an isolate from the donor's urine. On October 30, 2009, the Texas Department of State Health Services requested assistance from CDC to investigate this transplant-associated E. coli transmission and make recommendations to prevent future transmissions. The investigation identified gaps in communicating important donor information that might have adversely affected transplant outcomes. Each organ procurement organization (OPO) should establish protocols that clearly assign responsibilities for receiving, reviewing, and conveying any relevant donor information that becomes available subsequent to organ procurement.