Lung transplantation (LTx) donors with positive sputum cultures are generally considered extended criteria donors. Whether lungs with methicillin-resistant Staphylococcus aureus (MRSA) can be safely transplanted remains unclear. We investigated the effects of donor lungs with MRSA on post-transplant outcomes. This single-center retrospective review involved 163 patients who underwent deceased-donor LTx from 2015 to 2024. Patients were divided into two groups based on donor MRSA positivity. Background characteristics, short-term outcomes, post-transplant pneumonia-free survival, and overall survival were investigated. Patients of the MRSA (-) group were further subdivided by the presence of donor multidrug-resistant (MDR) bacteria other than MRSA. The MRSA (-) group (n = 150) and MRSA (+) group (n = 13) showed no differences in background characteristics, except for younger donor age in the MRSA (+) group (p = 0.01). Lengths of mechanical ventilation, intensive care unit stay, hospital stay, and necessity of tracheostomy were not statistically different between the two groups. Post-transplant pneumonia-free survival within 1 year and overall survival were also comparable. In the MRSA (-) group, the other MDR (+) subgroup showed significantly lower post-transplant pneumonia-free survival than the other MDR (-) subgroup (p = 0.03). A Cox proportional hazards regression model identified other MDR bacteria as a significant risk factor for post-transplant pneumonia-free survival (adjusted hazard ratio: 1.90, p = 0.03). Transplanting MRSA-positive lungs did not adversely affect outcomes compared with MRSA-negative lungs. However, transplanting lungs with MDR bacteria other than MRSA was associated with a higher incidence of post-transplant pneumonia.
Takada et al. (Sat,) studied this question.