title: 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.
authors.affiliation: Department of Anesthesiology and Intensive Care, Liver Transplantation Center, San Giovanni Battista Hospital, Turin, Italy. ecerutti@molinette.piemonte.it
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cerutti
authors.forename: Chiara
authors.initials: C
authors.lastname: Stratta
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.forename: Roberto
authors.initials: R
authors.lastname: Serra
authors.forename: Mirella
authors.initials: M
authors.lastname: Lepore
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fop
authors.forename: Luciana
authors.initials: L
authors.lastname: Mascia
authors.forename: Francesco
authors.initials: F
authors.lastname: Lupo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchello
authors.forename: Angelo
authors.initials: A
authors.lastname: Panio
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000635:transmission*; D001826:Body Fluids / Q000382:microbiology; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000635:transmission; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000635:transmission*; D019188:Organ Preservation Solutions; D011183:Postoperative Complications / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
chemical_list: D019188:Organ Preservation Solutions