Bacterial donor-derived infections in kidney and liver transplantation: a systematic review and meta-analysis

Solid organ transplantation (SOT) improves the survival and quality of life in patients with end-organ dysfunction; liver transplantation is a pivot therapy for acute and chronic end-stage liver diseases, and kidney transplantation is performed to prolong and improve the lives of those with end-stage renal disease. The advancements in surgical techniques, immunosuppressive therapies, and infection control and prophylaxis, along with significant changes in the policy of graft recruitment and allocation altered dramatically the characteristics of patients undergoing solid organ transplantation (SOT) in recent years. In fact, an increasing rate of patients being transplanted in critical condition, directly transferred from intensive care units (ICUs), often receiving non-standard organs, is commonly observed. The growing disparity between organ availability and the number of candidates for organ transplantation has led most transplant centres to turn their attention from “optimal” cadaveric donors to “marginal” or “suboptimal” donors. Infection transmission from donor to recipient is a dreadful complication in transplantation. Although bacteremia was previously detected in 5% of donors without a negative impact on recipient outcome, the current expansion of the graft pool requires consideration of the infectious risk associated with suboptimal donors. In the literature, there are documented instances of transmission of infectious agents from donor to recipient causing arterial anastomotic disruption, poor graft function, sepsis, and death, but without an updated meta-analysis. Besides the direct transmission of the infection, the release of endotoxins or other bacterial products has also been proposed to contribute to the primary non-function of the allograft. Screening of donors and the use of prophylactic antimicrobials have reduced the incidence of donor-derived infections. However, transmission can occur despite the adoption of defined screening and prevention strategies, and may result in increased morbidity and mortality. Organs from deceased donors with severe infections caused by susceptible bacteria have been procured and successfully transplanted with no evidence of transmission of infection, increase in rejection or influence on graft survival. More recently, reports of patients admitted to the intensive care unit (ICU) and exposed to multidrug-resistant (MDR) bacteria are available and, therefore, potential organ donors can be exposed to these organisms. The aim of this systematic review was to explore the possible relationship between donor bacterial infection and recipient prognosis and graft function, including all studies regarding liver and kidney transplantation.