Incidence of catheter-related bloodstream infection (CRBSI) in immunosuppressed hosts post solid organ transplant (SOT): a single center experience.

Introduction: Catheter-related bloodstream infections (CRBSI) incidence is well-studied in general hemodialysis patients. There is a lack of data on CRBSI rates specifically in solid organ transplant (SOT) recipients requiring hemodialysis. This study aims to investigate CRBSI incidence in this population at a single center.

Methods: This retrospective, single-center cohort study at Massachusetts General Hospital (MGH) investigated CRBSI incidence in non-kidney SOT (i.e., heart, lung, liver) who required hemodialysis via a tunneled dialysis catheter (TDC). Data was collected from January 2016 to October 2024, with patients followed for up to two years post-transplant or until death/end of study.

Results: 42 individuals met the study's inclusion criteria. The mean age of this cohort was 57 years, 50% were male, and 81% were White. The group consisted of 17 liver transplant recipients (40.5%), 13 heart transplant recipients (31.0%), and 12 lung transplant recipients (28.6%). Among the 12 lung transplant recipients, 8 received basiliximab induction, and 4 received no antibody induction therapy. 97% of the patients received mycophenolate mofetil, tacrolimus, and prednisone, while 3% received steroid-free maintenance. The median follow-up was 51.5 days (interquartile range 16-233). During this period, six individuals developed CRBSI, resulting in an incidence rate of 0.86 infections per 1,000 catheter-days. No deaths were attributed to CRBSI.

Conclusions: Our findings suggest that intense immunosuppression in the setting of SOT is not associated with an increased risk of CRBSI in patients with renal failure utilizing TDC especially when a consistent and standardized protocol for the access and care of these catheters is utilized.