Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The growing number of patients with terminal organ failure waiting for transplantation and the limited number of available organs demand that explantation teams see braindead patients with infectious diseases such as bacterial meningoencephalitis as potential donors, although until recently organ explantation from such donors has been contraindicated. This paper presents the first case of successful organ explantation from a donor with confirmed bacterial meningoencephalitis in our country. In this previously healthy patient (only with mild arterial hypertension in personal history), bacterial meningoencephalitis caused fulminant worsening and he deteriorated from mild disorder of consciousness (GCS 12) to brain death within only 24 hours. After the transplantation of organs was performed (heart, kidneys, liver and corneas were explanted), antibiotic therapy was continued in all organ recipients and two days after the transplantation none of the recipients showed any signs of infectious complications. This paper proves that this type of patients should also be treated as potential donors, under condition of appropriate microbiological diagnosis, antibiotic therapy and sustained hemodynamic stability, which should enlarge the number of organs available for transplantation.Sve veći broj bolesnika s terminalnim zatajenjem organa koji čekaju na presađivanje organa i ograničeni broj dostupnih organa nalažu da timovi za eksplantaciju razmatraju moždano mrtve bolesnike infektivnim bolestima kao što je bakterijski meningoencefalitis kao potencijalne donore organa, iako je eksplantacija organa kod takvih donora donedavno bila kontraindicirana. Ovdje se prikazuje prvi slučaj uspješne eksplantacije organa kod donora s potvrđenim bakterijskim meningoencefalitisom u našoj zemlji. Bolesnik je prethodno bio zdrav (samo s blagom arterijskom hipertenzijom u anamnezi), ali je meningoencefalitis uzrokovao veoma naglo pogoršanje koje je od blažeg poremećaja svijesti (Glasgowska ljestvica za komu, GCS 12) dovelo do moždane smrti u samo 24 sata. Nakon transplantacije organa (eksplantirani su srce, bubrezi, jetra i rožnice) nastavilo se s antibiotskom terapijom kod svih primatelja organa i dva dana nakon presađivanja nijedan od primatelja organa nije imao nikakvih znakova infektivnih komplikacija. Ovaj rad pokazuje kako se ove bolesnike treba isto tako smatrati potencijalnim donorima, uz primjerenu mikrobiološku dijagnostiku, antibiotsku terapiju i održavanje hemodinamske stabilnosti, čime bi se povećao broj organa dostupnih za presađivanje
