Multi center expert consensus on prevention and treatment of carbapenem resistant <i>Klebsiella pneumoniae</i> infection in liver transplantation donors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KONG Lingxiang ¹ , WANG Shouping ¹ , XU Xi ¹ , XU Gang ¹ , LÜ Tao ¹ , YANG Jian ¹ , SONG Jiulin ¹ , YILIYAER Aierken ¹ , HE Min ² , ZHANG Zhongwei ² , HUANG Yiming ^3,4 , WANG Pusen ^3,4 , ZHAO Dong ^3,4 , GAO Wei ⁵ , GUO Wenzhi ⁶ , FU Zhiren ⁷ , LI Ming ⁸ , YANG Liang ⁹ , LI Lijuan ¹⁰ , HE Yufeng ¹⁰ , CHEN Senbiao ¹⁰ , LI Guangming ¹¹ , WU Zhongjun ¹² , LÜ Guoyue ¹³ ,  YI Huimin ¹⁰ ,  ZHONG Lin ^3,4 ,  YANG Jiayin ¹

1. Liver Transplant Center, Organ Transplant Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Organ Transplantation ICU, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518112, P. R. China;
4. National Clinical Research Center for Infectious Disease, Shenzhen, Guangdong 518112, P. R. China;
5. Department of Liver Transplantation, Organ Transplantation Center, Tianjin First Central Hospital, Tianjin 300190, P. R. China;
6. Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;
7. Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, P. R. China;
8. Hepatobiliary and Pancreatic Surgery, General Surgery Department, Chengdu Third People’s Hospital, Chengdu 610041, P. R. China;
9. School of Medcine, Southern University of Science and Technology, Shenzhen, Guangdong 518055, P. R. China;
10. Organ Transplantation ICU, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, P. R. China;
11. Organ Transplant Center, You’an Hospital, Capital Medical University, Beijing 100069, P. R. China;
12. Organ Transplant Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
13. Organ Transplant Center, The First Hospital of Jilin University, Changchun 130031, P. R. China;

Corresponding author：

YI Huimin, Email: ylhmin@hotmail.com; ZHONG Lin, Email: zhonglin1@medmail.com.cn; YANG Jiayin, Email: doctoryjy@scu.edu.cn

Keywords：

donor-derived infection; carbapenem-resistant Klebsiella pneumoniae; liver transplantation; organ donation after citizen death

DOI：

10.7507/1007-9424.202502012

Video：

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Liver transplantation is currently the only effective curative treatment for end-stage liver disease. In recent years, with advancements in liver transplantation surgery and anti-rejection drugs, the incidence of surgical complications and organ rejection has gradually decreased. Conversely, transplant-related infections have increasingly become a major factor affecting the prognosis of transplant recipients. Furthermore, due to the progress in critical life support technologies, the time spent in the donor’s intensive care unit (ICU) has been extended, and post-transplant infections originating from the donor, especially donor-derived infection (DDI), have become one of the primary sources of infection for recipients. Studies have shown that infections in liver transplant recipients are often caused by Gram-negative pathogens, particularly carbapenem-resistant Klebsiella pneumoniae (CRKP), which has now become the leading cause of fatal infections in liver transplant recipients. To reduce the risk of donor-derived infections, it is necessary to strengthen donor screening and evaluation, establish standardized testing processes, and adjust the use strategies of post-transplant anti-infective drugs and immunosuppressants. Monitoring the immune status of recipients is also crucial. Multidisciplinary collaboration and the application of new technologies will be key in future infection prevention and control. To promote the prevention and treatment of CRKP-related donor infections, West China Hospital of Sichuan University, in collaboration with international experiences, has organized relevant experts to develop an expert consensus on the prevention and treatment of CRKP-targeted DDI.

Citation： KONG Lingxiang, WANG Shouping, XU Xi, XU Gang, LÜ Tao, YANG Jian, SONG Jiulin, YILIYAER Aierken, HE Min, ZHANG Zhongwei, HUANG Yiming, WANG Pusen, ZHAO Dong, GAO Wei, GUO Wenzhi, FU Zhiren, LI Ming, YANG Liang, LI Lijuan, HE Yufeng, CHEN Senbiao, LI Guangming, WU Zhongjun, LÜ Guoyue, YI Huimin, ZHONG Lin, YANG Jiayin. Multi center expert consensus on prevention and treatment of carbapenem resistant Klebsiella pneumoniae infection in liver transplantation donors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 133-142. doi: 10.7507/1007-9424.202502012 Copy

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1. Yang Y, Yang Y, Ahmed MAEE, et al. Carriage of distinct bla_KPC-2 and bla_OXA-48 plasmids in a single ST11 hypervirulent Klebsiella pneumoniae isolate in Egypt. BMC Genomics, 2022, 23(1): 20. doi: 10.1186/s12864-021-08214-9.
2. Zhang X, Ouyang J, He W, et al. Co-occurrence of rapid gene gain and loss in an interhospital outbreak of carbapenem-resistant hypervirulent ST11-K64 Klebsiella pneumoniae. Front Microbiol, 2020, 11: 579618. doi: 10.3389/fmicb.2020.579618.
3. Shao C, Jin Y, Wang W, et al. An outbreak of carbapenem-resistant Klebsiella pneumoniae of K57 capsular serotype in an emergency intensive care unit of a teaching hospital in China. Front Public Health, 2021, 9: 724212. doi: 10.3389/fpubh.2021.724212.
4. Gu D, Dong N, Zheng Z, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis, 2018, 18(1): 37-46.
5. Cejas D, Fernández Canigia L, Rincón Cruz G, et al. First isolate of KPC-2-producing Klebsiella pneumonaie sequence type 23 from the Americas. J Clin Microbiol, 2014, 52(9): 3483-3485.
6. Kang Y, Xu C, Ma W, et al. Genomic characterization of ST11-KL25 hypervirulent KPC-2-producing multidrug-resistant Klebsiella pneumoniae from China. iScience, 2024, 27(12): 111471. doi: 10.1016/j.isci.2024.111471.
7. Kim HK, Park YK, Wang HJ, et al. Epidemiology and clinical features of post-transplant bloodstream infection: an analysis of 222 consecutive liver transplant recipients. Infect Chemother, 2013, 45(3): 315-324.
8. Guo L, Peng P, Peng WT, et al. Klebsiella pneumoniae infections after liver transplantation: drug resistance and distribution of pathogens, risk factors, and influence on outcomes. World J Hepatol, 2024, 16(4): 612-624.
9. Pereira MR, Scully BF, Pouch SM, et al. Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl, 2015, 21(12): 1511-1519.
10. Kalpoe JS, Sonnenberg E, Factor SH, et al. Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl, 2012, 18(4): 468-474.
11. 中华医学会器官移植学分会, 中华预防医学会医院感染控制学分会, 复旦大学华山医院抗生素研究所. 中国实体器官移植供者来源感染防控专家共识 (2018版). 中华器官移植杂志, 2018, 39(1): 41-52.
12. Aguado JM, Silva JT, Fernández-Ruiz M, et al. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando), 2018, 32(1): 36-57.
13. 钟林, 杨超, 杨家印, 等. 国家科技部重点研发计划 (2022YFC2304700). 2024 (中期报告). (2024-10-31) [2025-2-10] https://www.most.gov.cn/index.html.
14. Lübbert C, Becker-Rux D, Rodloff AC, et al. Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case-control analysis. Infection, 2014, 42(2): 309-316.
15. Gasink LB, Edelstein PH, Lautenbach E, et al. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol, 2009, 30(12): 1180-1185.
16. Hu Y, Ping Y, Li L, et al. A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients. J Infect Dev Ctries, 2016, 10(3): 208-213.
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