Bacterial- and fungal-positive cultures in organ donors: Clinical impact in liver transplantation

Abstract

Infection transmission from donor to recipient is a dreadful complication in transplantation. Although bacteremia was previously detected in 5% of donors without negative impact on recipient outcome, the current expansion of graft pool requires consideration of the infectious risk associated with suboptimal donors. This study aims to evaluate the incidence and risk factors of infection in unselected cadaveric liver donors, the occurrence of microorganism transmission to recipient and its influence on patient survival. Results of microbiologic cultures obtained before harvesting in intensive care unit (ICU) and routinely at harvesting from 610 consecutive liver donors were retrospectively analyzed. Evidence for bacterial and fungal transmission to the recipient was searched for in each culture-positive donor. One or more cultures were positive in 293 donors (48%), while bacteremia was present in 128 (21%). Culture-positive and bacteremic donors were of significantly older age and had longer ICU stays. At multivariate analysis, an ICU stay of 3 or more days was the only significant predictor of donor infection. Although 1-year patient/graft survival rates were not influenced by donor culture positivity, pathogen transmission occurred in 11 cases with high recipient 1-year mortality (45%). In those 11 cases, median donor age was 74 years, significantly much older than that of the other culture-positive donors. In conclusion, donors with a prolonged ICU stay are at increased risk of infection, while older donor age is associated with pathogen transmission to the recipient. Adequate donor maintenance and careful microbiologic surveillance and treatment, especially of elderly donors, may limit transmission of donor infection.

Evaluation of the presence of microorganisms in solid-organ preservation solution

“…and several others. 4,5,17 All of the aforementioned agents were found in this study, totaling 71% of all microorganisms.…”

“…In a study conducted by Cerutti et al, 5 mortality in the first year after transplant was significantly higher (5/11, 45%) when transmission of infection from donor to recipient occurred than when it did not (49/547, 9%). In a study, Len et al 20 demonstrated that the transmission of infection from donor to recipient was documented in 5 of 292 patients (1.71%), 2 of whom did not survive the infection (40%).…”

“…Unfortunately, such techniques are not widely available, and their application to microorganisms isolated in different laboratories is not feasible. 5 In this study, the possible occurrence of transmission of the infectious agent from donor to recipient was only inferred when the same species was identified in both samples. Antimicrobial susceptibility could have also provided valuable information in this regard if it had been tested.…”

“…4 Concerning brain-dead donors, there is a higher risk of infection due to severe impairment of the cellular immune system, as well as hemodynamic instability, and subsequent bacterial translocation from the gut. 5 …”

Successful liver transplantation from a living donor with asymptomatic pulmonary cryptococcosis

“…12,13 The rate of infection due to a donor organ infection is as low as 0.96% 8 with adequate preoperative antibiotic prophylaxis and aseptic organ retrieval. [14][15][16][17] We believe that adequately treated pretransplant cryptococcosis in a donor will not pose a significant risk of transmission.…”