Risk factors for infection and pathogen transmission from liver donors

This month's issue of Liver Transplantation shows that prolonged intensive care unit stay increases infection risk, while older donor age is associated with recipient pathogen transmission.

Infection transmission from donor to recipient is a dreadful complication in transplantation.

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.

Dr Elisabetta Cerutti and colleagues from Italy evaluated the incidence and risk factors of infection in unselected cadaveric liver donors.

In addition, the investigative team assessed the occurrence of microorganism transmission to recipient and its influence on patient survival.

Results of microbiologic cultures obtained before harvesting in intensive care unit 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.

1 or more cultures were positive in 48% of donors

Liver Transplantation

The investigators found that 1 or more cultures were positive in 48% of donors.

Bacteremia was present in 21%.

The team observed that culture-positive and bacteremic donors were of significantly older age and had longer intensive care unit stays.

At multivariate analysis, an intensive care unit stay of 3 or more days was the only significant predictor of donor infection.

The investigators noted that 1-year patient/graft survival rates were not influenced by donor culture positivity.

However, pathogen transmission occurred in 45% of cases with high recipient 1-year mortality.

The investigators found that in those cases, median donor age was 74 years, significantly much older than that of the other culture-positive donors.

Dr Cerutti's team concludes, “Donors with a prolonged intensive care unit 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.”