Solid Organ Transplantation From Deceased Donors With Infective Endocarditis: The UK Experience
Greenhall GHB, Robb M, Brown C, Johnson R, Tomlinson LA, Callaghan CJ, Watson CJE
Supplemental digital content
Table legend s
Table S1. Cause of death in all utilized donors with infective endocarditis
Table S2. Characteristics of kidney transplants from donors with infective endocarditis and matched control transplants from donors dying of other causes
Table S3. Characteristics of liver transplants from donors with infective endocarditis and matched control transplants from donors dying of other causes
Table S4. Characteristics of consented donors with endocarditis and matched control donors dying of other causes
Table S5. Primary reasons for decline of transplant offers from consented donors with infective endocarditis
Table S6. Primary reasons for nonuse of retrieved transplant offers from consented donors with infective endocarditis
Figure legend s
Figure S1. Kaplan-Meier plot showing all-cause allograft failure in adult UK deceased donor single kidney transplants, 2001-2018
Figure S2. Kaplan-Meier plot showing all-cause allograft failure in adult UK deceased donor liver transplants, 2001-2018
Figure S3. Kaplan-Meier plot showing patient survival in kidney transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Figure S4. Kaplan-Meier plot showing death-censored allograft survival in kidney transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Figure S5. Kaplan-Meier plot showing patient survival in liver transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Figure S6. Kaplan-Meier plot showing death-censored allograft survival in liver transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Figure S7. Flowchart of solid organ utilization in consented donors with infective endocarditis
Table S1. Cause of death in all utili
zed donors with infective endocarditis
Utilizeddonors (n=42) 29 (67%) 3 (7%) 2 (5%) 6 (14%) Intracranial hemorrhage
Intracranial thrombosis Hypoxic brain damage
Cerebrovascular accident(typeunspecified)
Septicemia 2 (5%)
Table S2. Characteristics of kidney transplants from donors with infective endocarditis and matched control transplants from donors dying of other causes
Transplants from donors with infective endocarditis (n=41)
Matched control transplantsa (n=164)
Donor factors
Age (years)* 45 (37 – 53) 46 (37 – 54)
Male sex* 27 (66%) 108 (66%)
Donor type*
DBD 34 (83%) 136 (83%)
DCD 7 (17%) 28 (17%)
Cause of death
26 (63%) 92 (56%)
10 (24%) 10 (6%)
0 14 (9%)
Intracranial hemorrhage Other / unspecified stroke Trauma
Other 5 (12%) 47 (29%)
Terminal creatinine (µmol/L) 83 (58 – 128) 74 (57 – 99) Recipient factors
44 (34 – 54) 44 (33 – 55)
26 (63%) 104 (63%)
4 (10%) 13 (8%)
9 (22%) 15 (9%)
38 (93%) 154 (94%)
Age (y)*
Male sex*
Diabetes
Highly sensitizedb On dialysis at transplant HLA mismatch levelc
1 4 (10%) 27 (16%)
2 22 (54%) 71 (43%)
3 14 (34%) 58 (35%)
4 1 (2%) 8 (5%)
Graft number
First 31 (75%) 138 (84%)
Second or higher order 10 (25%) 26 (16%)
Transplant factors Calendar period*
2001 – 2006 9 (22%) 36 (22%)
2007 – 2012 11 (27%) 44 (27%)
2013 – 2018 21 (51%) 84 (51%)
Cold ischemic time (hrs) 16 (12 – 19) 15 (12 – 18) Data are n (%) or median (IQR)
DBD, Donation after brainstem death; DCD, donation after circulatory death
aMatched to transplants from donors with infective endocarditis on donor/recipient age (± 5 y) and sex, donor type and calendar period, with a ratio of 4:1.
bCalculated reaction frequency >85%.
cLevel 1, 0 mismatches; level 2, 0 HLA-DR mismatches and 0/1 HLA-B mismatch; level 3, 0 HLA-DR mismatches and 2 HLA-B mismatches or 1 HLA-DR mismatch and 0/1 HLA-B mismatch; level 4, 2 HLA- DR mismatches or 1 HLA-DR and 2 HLA-B mismatches.
*Matching variables.
Missing data (n): cold ischemia time (2); donor cause of death (1)
Table S3. Characteristics of liver transplants from donors with infective endocarditis and matched control transplants from donors dying of other causes
Transplants from donors with infective endocarditis (n=37)
Matched control transplants a (n=148)
Donor factors
44 (35 – 53) 46 (34 – 53)
26 (70%) 104 (70%)
34 (92%) 136 (92%)
3 (8%) 12 (8%)
Age (y)*
Male sex*
Donor type*
DBD DCD
Cause of death
27 (73%) 79 (53%)
7 (19%) 9 (6%)
0 14 (9%)
Intracranial hemorrhage Other / unspecified stroke Trauma
Other 3 (8%) 43 (29%)
Recipient factors
48 (41 – 56) 48 (42 – 57)
26 (70%) 104 (70%)
21 (16 – 23) 16 (13 – 21)
7 (19%) 29 (20%)
Age (y)*
Male sex*
MELD scoreb HCV positive Urgency
Elective 33 (89%) 124 (84%)
Urgent 4 (11%) 24 (16%)
Graft number
First 30 (81%) 130 (88%)
Second or higher order 7 (19%) 18 (12%)
Transplant factors Calendar period *
2001 – 2006 6 (16%) 24 (16%)
2007 – 2012 11 (30%) 44 (30%)
2013 – 2018 20 (54%) 80 (54%)
Cold ischemic time (hrs) 9 (8 – 12) 9 (7 – 10) Data are n (%) or median (IQR)
DBD, Donation after brainstem death; DCD, donation after circulatory death; MELD, Model for End-stage Liver Disease; HCV, hepatitis C virus
aMatched to transplants from donors with infective endocarditis on donor/recipient age (± 5 y) and sex, donor type and calendar period, with a ratio of 4:1.
bElective recipients only; calculated as 9.57 ln(creatinine mg/dl) + 3.78 ln(bilirubin mg/dl) + 11.2 ln(INR) + 6.43
*Matching variables
Missing data (n): cold ischemic time (1), donor cause of death (3)
Table S4. Characteristics of consented donors with endocarditis and matched control donors dying of other causes
Donors with infective endocarditis
(n=65)
Matched control donorsa (n=260)
47 (40 – 55) 48 (40 – 56)
46 (71%) 184 (71%)
45 (69%) 136 (69%)
20 (31%) 12 (31%)
Age (y)*
Male sex*
Donor type*
DBD DCD
Cause of death
44 (68%) 135 (52%)
14 (22%) 21 (8%)
0 22 (8%)
Intracranial hemorrhage Other / unspecified stroke Trauma
Other 7 (11%) 78 (30%)
8 (12%) 3 (1%)
4 (6%) 5 (2%)
4 (6%) 23 (9%)
15 (23%) 56 (22%)
History of IVDU HCV positive History of diabetes History of hypertension Calendar period*
2001 – 2006 8 (12%) 32 (12%)
2007 – 2012 23 (35%) 92 (35%)
2013 – 2018 34 (52%) 136 (52%)
Terminal creatinine (µmol/L) 76 (58 – 97)
<100 28 (43%) 195 (75%)
100 to <150 16 (25%) 32 (12%)
≥150 20 (31%) 27 (10%)
Data are n (%) or median (IQR)
DBD, Donation after brainstem death; DCD, donation after circulatory death; IVDU, intravenous drug use;
HCV, hepatitis C virus
aMatched to donors with infective endocarditis on donor age (± 5 y) and sex, donor type and calendar period, with a ratio of 4:1.
*Matching variables
Missing data (n): donor cause of death (4), HCV status (14), history of diabetes (12), history of hypertension (15), terminal creatinine (7)
Table S3. Primary reasons for decline of transplant offers from consented donors with infective endocarditis
(total transplant offers=267)
Reason recorded Count
56 18 13 9 8 4 2 2 2 1 1 1 1 1 Donor unsuitable - past history
Poor function
Donor unsuitable - virology Infection
Donor unsuitable - size No suitable recipients Donor unsuitable - age
Permission refused by coroner Tumor
Center already retrieving/transplanting Center criteria not achieved
Fatty organ HLA/ABO type Organ damaged
Other 18
Total solid organ transplant offers declined 137
Notes:
1. Excludes heart, heart-lung and pancreas islet cell transplant offers 2. Split liver transplant offers recorded separately
3. Bilateral lung transplant offers recorded once
4. Components of multivisceral transplant offers recorded separately 5. Includes offers made to recipients outside UK
6. Excludes offers made for research purposes only
Table S3. Primary reasons for nonuse of retrieved transplant offers from consented donors with infective endocarditis
(total offers retrieved=130)
Reason recorded Count
5 5 3 2 1 1 1 11 Anatomical
Tumor
Poor perfusion Infection
Organ damaged Recipient refused
Whole organ cut down for transplant Other
Total retrieved offers not transplanted 29
Notes:
1. Excludes retrievals for heart, heart-lung and pancreas islet cell transplants 2. Liver retrievals for split transplants recorded separately
3. Bilateral lung retrievals recorded once
4. Retrievals for each component of multivisceral transplant recorded separately 5. Includes offers made to recipients outside UK
Figure S1. Kaplan-Meier plot showing all-cause allograft failure in adult UK deceased donor single kidney transplants, 2001-2018
Note: Analysis restricted to first transplant in each recipient during study period.
Figure S2. Kaplan-Meier plot showing all-cause allograft failure in adult UK deceased donor liver transplants, 2001-2018
Note: Analysis restricted to first transplant in each recipient during study period.
Figure S3. Kaplan-Meier plot showing patient survival in kidney transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Note: Control transplants matched on donor and recipient sex and age (± 5 y), donor type (DBD/
DCD) and calendar period, with a ratio of 4:1.
Figure S4. Kaplan-Meier plot showing death-censored allograft survival in kidney transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Note: Control transplants matched on donor and recipient sex and age (± 5 y), donor type (DBD/
DCD) and calendar period, with a ratio of 4:1.
Figure S5. Kaplan-Meier plot showing patient survival in liver transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Note: Control transplants matched on donor and recipient sex and age (± 5 y), donor type (DBD/
DCD) and calendar period, with a ratio of 4:1.
Figure S6. Kaplan-Meier plot showing death-censored allograft survival in liver transplants from deceased donors with infective endocarditis and matched control transplants from donors dying of other causes, 2001-2018
Note: Control transplants matched on donor and recipient sex and age (± 5 y), donor type (DBD/
DCD) and calendar period, with a ratio of 4:1.
Figure S7. Flowchart of solid organ utili
zation in consented donors with infective endocarditis
Notes:
1. Right and left lungs recorded separately
2. Pancreas offers include offers for islet cell transplant (4 offered; 2 retrieved; none transplanted).
3. Includes organs transplanted outside UK (1 liver)
4. Includes organs from donors with endocarditis without known causative organism (3 transplanted:
2 kidneys, 1 liver)
5. Excludes organs offered and retrieved for research purposes only
6. Livers used for split transplants recorded once (2 livers; 4 split transplants) 7. “Declined”; declined by all centers to which organ was offered
