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UPMC: Transplant program shut down as mold investigation continues

Ben Schmitt
| Monday, Sept. 21, 2015, 6:49 p.m.
The main entrance of UPMC Presbyterian in Oakland.
Trib Total Media
The main entrance of UPMC Presbyterian in Oakland.
UPMC Hospitals along Forbes Avenue in Oakland.
UPMC Hospitals along Forbes Avenue in Oakland.

Health care giant UPMC temporarily halted its internationally known transplant program Monday in a mold outbreak that might have contributed to the deaths of three patients and sickened a fourth.

The unprecedented closure affects all UPMC transplant candidates, including those awaiting kidneys, livers, hearts, lungs and intestines. Officials called the shutdown voluntary and said the decision resulted from discussions with the Pennsylvania Department of Health, the U.S. Centers for Disease Control and Prevention and the United Network for Organ Sharing, the nonprofit that manages the nation's organ transplant program.

About 1,300 patients are registered on the wait list at UPMC, one of the busiest transplant centers in the world. The center performs about 400 transplants a year.

“UPMC is reaching out to all of our patients with scheduled organ transplants to inform them of the situation and develop an appropriate plan for their clinical management,” said Dr. Steven Shapiro, UPMC's chief medical and scientific officer. “We will do everything we can to make sure patients receive lifesaving transplants if they are critically ill.”

He said UPMC has no patients in imminent need of a transplant and expects the transplant postponement to last “two to three days.”

If an emergency arises, Shapiro said, UPMC has several facilities licensed for transplants and could reach out to other hospital systems as a backup plan.

Allegheny General Hospital in the North Side and VA Pittsburgh Healthcare System's Oakland campus are licensed to perform organ transplants. AGH officials reached out to UPMC to offer assistance in the transition of any patients, said spokesman Dan Laurent.

A team from the CDC is expected to arrive in Pittsburgh on Tuesday to assist with the investigation.

“They will tour the facilities with us, and by seeing everything in person, possibly come up with ideas we didn't have during our phone conversations,” Shapiro said. “We want to do everything we can to make sure that we have the safest environment.”

Dr. Amesh Adalja, a Pittsburgh-based infectious diseases expert who serves as a spokesman for the Infectious Diseases Society of America, said a short-term pause in transplants is a good idea.

“Until the root cause of the mold infections is more definitively established and understood, it is valid and proactive to voluntarily suspend transplantation to ensure the highest level of patient safety going forward,” Adalja said.

Dr. Ernest Chiodo, a Chicago-based industrial hygienist, agreed.

“If there's enough of a concern about a problem, then the proper public health approach is to act as if the problem's there until you can prove there's not a problem,” Chiodo said.

Last week, officials confirmed deaths of three transplant patients, with the most recent occurring Thursday night in UPMC Montefiore. The other two patients had been treated in the same room of a now-shuttered cardiothoracic intensive care unit in UPMC Presbyterian, which is next door to Montefiore. They died in June and October 2014.

A male lung transplant patient, who was treated in the same Presby ICU, is battling a fungal infection on his lung tissue. His condition is guarded, Shapiro said.

As part of its investigation, UPMC said, 11 transplant patients in Presby have been placed on a new antifungal medication, even though they have showed no signs of infection.

Investigators are awaiting results of cultures taken on samples in locations throughout Presby and Montefiore.

“As a precaution, linens for our immunocompromised patients will remain completely sealed in plastic from the moment they leave the cleaning facility until they arrive in our intensive care unit,” Shapiro said. “While we do not have evidence that linens were involved in the fungal infections at UPMC, they have been found to be the culprit in mold cases at other hospitals nationwide.”

Presby administrators ordered the relocation of all cardiothoracic ICU patients Sept. 8, five days after doctors diagnosed the lung transplant patient with a mold infection. The unit typically handles patients with heart and lung diseases who are admitted for heart procedures or transplants.

The Tribune-Review first reported the shutdown of Presby's ICU and relocation of 18 patients.

UPMC identified the types of mold detected as rhizomucorm, lichtheimia and rhizopus. These fungi are typically found in the soil and in association with decaying organic matter, such as leaves, compost piles or rotten wood, according to the CDC.

Pennsylvania Department of Health Secretary Karen Murphy said her office will assist the CDC in its investigation. The department licenses all hospitals in the state. CDC officials will lead the investigation, she said.

“We are committed to ensuring the safety of patients at UPMC, and the Department of Health is actively engaged in the investigation,” Murphy said in a statement. “The safety of patients is our top priority and we will continue to work with our partners in the federal government as well as UPMC to find the best path forward.”

Ben Schmitt is a staff writer for Trib Total Media. He can be reached at 412-320-7991 or bschmitt@tribweb.com. Staff writer Wes Venteicher contributed to this report.

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