Scientific letter
Liver transplantation from a donor with multidrug-resistant Acinetobacter baumannii infection. Is it a risk?
Trasplante hepático de un donador con infección por Acinetobacter baumannii multidrogorresistente. ¿Representa un riesgo?
C.J. García-Carreraa, F.E. Rivera-Lopeza, B. Papacristofilou-Riebelinga, O.A. Fernández-Garcíab, I. García-Juáreza,
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drinter77@gmail.com
Corresponding author at: Av. Vasco de Quiroga #15. Col. Belisario Domínguez Sector XVI. C.P. 14080. Tlalpan, Mexico City. Tel.: +52 55-5487-0900 ext. 5051.
Corresponding author at: Av. Vasco de Quiroga #15. Col. Belisario Domínguez Sector XVI. C.P. 14080. Tlalpan, Mexico City. Tel.: +52 55-5487-0900 ext. 5051.
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Tel.: +52 55-5487-0900 ext. 5051." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante hepático de un donador con infección por <span class="elsevierStyleItalic">Acinetobacter baumannii</span> multidrogorresistente. ¿Representa un riesgo?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Orthotopic liver transplantation (OLT) is the treatment of choice for patients with end-stage liver disease, acute liver failure, hepatocellular carcinoma, and other liver diseases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However, the mortality rate for patients on the liver transplant waiting list has increased due to high demand and organ scarcity worldwide, including Mexico.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> To resolve this problem, efforts have been made to broaden the potential donor pool, including some donors considered “high risk” or marginal; for example, donors with positive blood cultures, whose organs can be safely transplanted, with the exception of those with sepsis and multiorgan failure at the time of procurement.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present herein the case of an OLT recipient whose donor had confirmed bacteremia due to multidrug-resistant (MDR) <span class="elsevierStyleItalic">Acinetobacter baumannii</span> (<span class="elsevierStyleItalic">A. baumannii</span>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A 66-year-old man, whose current disease appeared in 2016, characterized by general malaise, variceal bleeding, ascites, and grade II hepatic encephalopathy. He was diagnosed with cirrhosis of the liver due to metabolic dysfunction-associated fatty liver disease (MAFLD), after ruling out other etiologies. Two years after his disease onset, the patient developed three lesions under 4<span class="elsevierStyleHsp" style=""></span>cm, consistent with hepatocellular carcinoma. He received three sessions of locoregional treatment with transarterial embolization, with no complications. Six months after the final treatment, the patient maintained the Milan criteria and was evaluated for liver transplantation, with no contraindications. He was placed on the waiting list in 2019.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After three years on the waiting list, with no recurrence of hepatocellular carcinoma, the patient was offered an organ from a 56-year-old female donor. Overweight was her only comorbidity, and her blood group was compatible with his. The donor died from a hemorrhagic stroke and was maintained in the intensive care unit. Two days before brain death occurred, she had presented with fever. MDR <span class="elsevierStyleItalic">A. baumannii</span> that was only sensitive to tigecycline developed in her blood cultures. Treatment with that agent was begun and the central venous catheter was removed approximately 36<span class="elsevierStyleHsp" style=""></span>h before liver procurement.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After a brief pretransplant evaluation of the donor, with laboratory tests and a macroscopically normal liver, the risks presented by the blood cultures were discussed with the patient and he accepted them. The transplant was performed in May of 2022. As preventive measures, the blood cultures were repeated in the donor the day of the procurement and baseline blood cultures were carried out on the recipient, the results of which were negative. Antimicrobial prophylaxis with tigecycline for seven days was indicated. The patient had an excellent posttransplant recovery. During his hospital stay, the patient did not present with fever or signs of systemic inflammatory response, nor was modification of the traditional immunosuppression regimen necessary. He was discharged eight days after the procedure and currently has no complications at month 10 of follow-up.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Even though organ transplantation is considered a life-saving procedure, it is not without risks. One of the goals of liver transplant programs is to minimize the risk for unanticipated disease transmission between donors and recipients, in order to reduce posttransplant morbidity/mortality, which has been reported at up to 22%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A variety of pathogens, such as viruses, bacteria, fungi, mycobacteria, and parasites, can be transmitted by the donor. A review of the literature showed that the definition of infection in organs from donors varies according to the hospital center, which explains the wide range of cases of infection (from 2.2% to 23%). Despite those differences, case series have demonstrated that bacterial infection transmission from the donor to the recipient is not common, reaching 6.2%.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In our case report, the organ came from a female donor with documented MDR <span class="elsevierStyleItalic">A. baumannii</span> bacteremia. The recipient had excellent posttransplant progression, with no infectious complications, and antibiotic treatment was maintained for seven days.</p><p id="par0050" class="elsevierStylePara elsevierViewall">At present, numerous cases of solid organ transplantation from donors with positive blood cultures have been reported in the literature, and survival results are equal to those reported in noninfected organs (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Nevertheless, Tong et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> described a cohort of patients that underwent liver transplantation. Eighty-two patients were infected, 12 (14.6%) of whom had donor-derived infections. Five of those patients were infected with <span class="elsevierStyleItalic">A. baumannii</span> and three of them died. Mularoni et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> described a series in which four out of 14 recipients of organs from donors with infection/colonization caused by resistant Gram-negative bacilli presented with transmission of said bacteria. Those four recipients had not received treatment against isolates in the donor. The rest of the recipients received at least seven days of adequate treatment in the immediate posttransplant period.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In a context in which the quantity of organ donors is precarious, it is important to take advantage of any opportunity that implies obtaining a graft for patients on the waiting list, which can include an infected donor. The presence of bacterial infections in the potential donor does not preclude liver donation. Effective treatment should be started in the donor, and possible infectious foci controlled (changing of central venous catheters, arterial lines, etc.). Communication with the procurement team should be established, so that effective antimicrobial treatment is administered to the recipient.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0065" class="elsevierStylePara elsevierViewall">The present scientific letter rigorously meets the ethical considerations required for bioethical research, was authorized by the corresponding ethics committee. Importantly, to protect patient privacy, informed consent was not obtained, given that no personal information that could identify the patient was included in the content of the article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial disclosure</span><p id="par0070" class="elsevierStylePara elsevierViewall">No financial support was received in relation to this article.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial disclosure" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Carrera CJ, Rivera-Lopez FE, Papacristofilou-Riebeling B, Fernández-García OA, García-Juárez I. Trasplante hepático de un donador con infección por <span class="elsevierStyleItalic">Acinetobacter baumannii</span> multidrogorresistente. ¿Representa un riesgo? Rev Gastroenterol Mex. 2023;88:436–439.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0425" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transplanted organ(s) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical course \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Management \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cohen et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 kidneys1 liver3 lungs2 heartsfrom donors with septic shock due to <span class="elsevierStyleItalic">A. baumannii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A kidney transplant recipient had acute rejection that responded to treatment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meropenem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Except for one heart transplant (that failed due to primary graft failure), all were still alive on posttransplant day 60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No patient had positive <span class="elsevierStyleItalic">A. baumannii</span> cultures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Martins et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pneumonia with positive <span class="elsevierStyleItalic">A. baumannii</span> cultures on multiple occasions. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amikacin and polymyxin B, as well as reduced immunosuppression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Died on posttransplant day 61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Required amines, invasive ventilation and presented with kidney failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sözen et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver and 2 kidneys in different recipients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None in the three recipients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Teicoplanin, netromycin, and cefoperazone/sulbactam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No isolation in cultures in the three recipients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver and 2 kidneys (different recipients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empiric antibiotic therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The cultures of the 3 recipients were negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bardossy et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No clinical manifestations and/or infection. On day 12 alveolar lavage culture was positive for <span class="elsevierStyleItalic">A. baumannii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tigecycline IV for 19 days and colistin for 45 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Graft colonized by <span class="elsevierStyleItalic">A. baumannii</span> up to 6 months after transplant but with no function alterations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liver and 2 kidneys (different recipients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Empiric antibiotic therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The cultures of the 3 recipients were negative \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3422811.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case reports of solid organ transplants from donors with <span class="elsevierStyleItalic">Acinetobacter baumannii</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Donor-derived infections among Chinese donation after cardiac death liver recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Q.F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 8 | 9 | 17 |
| 2024 September | 96 | 31 | 127 |
| 2024 August | 100 | 32 | 132 |
| 2024 July | 85 | 61 | 146 |
| 2024 June | 74 | 36 | 110 |
| 2024 May | 75 | 52 | 127 |
| 2024 April | 137 | 57 | 194 |
| 2024 March | 204 | 37 | 241 |
| 2024 February | 178 | 52 | 230 |
| 2024 January | 174 | 59 | 233 |
| 2023 December | 73 | 56 | 129 |
| 2023 November | 52 | 52 | 104 |
| 2023 October | 58 | 49 | 107 |
| 2023 September | 91 | 72 | 163 |
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