title: Decreased graft survival in liver transplant recipients of donors with positive blood cultures: a review of the United Network for Organ Sharing dataset.
abstract: Liver transplantation using blood culture positive donors (BCPD) has allowed a significant expansion of the donor pool. We aimed to characterize BCPD and assess the outcomes of BCPD liver transplant recipients. We retrieved data from the United Network for Organ Sharing (UNOS) registry on all adults who underwent primary, single-organ deceased-donor liver transplantation in the USA between 2008 and 2013. Patients were classified into two cohorts: the BCPD cohort and the non-BCPD cohort. One-year graft and patient survival were compared between cohorts using Kaplan-Meier estimates and Cox models. A total of 28 961 patients were included. There were 2316 (8.0%) recipients of BCPD. BCPD were more likely to be older, female, black, diabetic, hypertensive, and obese compared to non-BCPD. Graft survival was significantly lower in BCPD recipients compared to non-BCPD recipients (Kaplan-Meier, 0.85 vs. 0.87; P = 0.009). Results remained significant in propensity-matched analysis (P = 0.038). BCPD was independently associated with decreased graft survival (adjusted HR; 1.10, 95% CI 1.01-1.20; P = 0.04). There were no significant differences in patient survival between study groups. BCPD was associated with decreased graft survival in liver transplant recipients. Studies are needed to identify subgroups of BCPD with the highest risk of graft failure and characterize the underlying pathogenic mechanisms.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.|Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Moises A
authors.initials: MA
authors.lastname: Huaman
authors.affiliation: Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Valery
authors.initials: V
authors.lastname: Vilchez
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Mei
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Malay B
authors.initials: MB
authors.lastname: Shah
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Daily
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Berger
authors.affiliation: Section of Transplant Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gedaly
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data
keywords: donor bacteremia; graft survival; infection; liver transplant; outcome; patient survival