Utility of deceased donor cultures in solid organ transplantation in preventing donor‐derived bacterial and fungal infectious diseases transmission

Abstract

Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor‐derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor‐derived infection (DDI) and the consequence of organ non‐utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.

Approach to suspected donor-derived infections

“…Donor-derived infections can be categorized into two groups: “expected” and “unexpected.” Expected transmission events occur when a known infection is identified in a potential donor, with the recognized potential for transmission to one or more recipients. The most common infections in this category are viral pathogens such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), and hepatitis B and C. Bacterial, fungal, and parasitic transmissions can also occur as the result of infection or colonization of the donor organ, contamination during organ recovery, or transmission through the bloodstream during the transplantation process ( 5 ). Preventative strategies such as targeted antimicrobial prophylaxis, perioperative infection prevention measures, and post-transplant surveillance can minimize the risk and impact of expected disease transmission.…”

Donor blood cultures and outcomes after lung transplantation: a single‐center report

“…3,8,9 Infections outside of target organs have a low risk of transmission and may be overlooked. 9 Solid organ transplantation from donors with isolated bacteremia may similarly be safe, although evidence is limited for lung transplantation. [10][11][12] Shah et al published the largest report of lung transplant donors with bacteremia and found no adverse effect on recipient survival.…”

“…Current guidelines recommend obtaining cultures from donor allografts and blood, as infections at these sites may increase the risk of invasive infections after transplantation and may adversely affect graft function 3,8,9 . Infections outside of target organs have a low risk of transmission and may be overlooked 9 . Solid organ transplantation from donors with isolated bacteremia may similarly be safe, although evidence is limited for lung transplantation 10–12 .…”