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The use of liver grafts from donors with bacterial meningitis
S Satoi1, S R Bramhall, M Solomon
1The Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
Insights
Liver transplantation from donors with bacterial meningitis is safe. Adequate antimicrobial therapy for both donors and recipients ensures successful outcomes, comparable to standard liver transplants.
Area of Science:
- Transplantation immunology
- Infectious diseases
- Hepatology
Background:
- Global shortage of suitable organ donors for transplantation.
- Potential risk of sepsis transmission from cadaveric donors with bacterial meningitis.
- Need to evaluate the safety of using livers from donors with meningitis.
Purpose of the Study:
- To assess the safety and outcomes of orthotopic liver transplantation (OLT) using livers from cadaveric donors with bacterial meningitis.
- To compare graft and patient survival rates with a control group.
Main Methods:
- Retrospective review of hospital records for recipients of liver transplants from donors with meningitis.
- Comparison with a matched control group of recipients from donors without meningitis.
- Analysis of donor pathogens, transplant types, and antimicrobial therapy protocols.
Main Results:
- 33 cadaveric donors with meningitis provided livers for 34 OLTs.
- No infectious complications from meningeal pathogens in recipients.
- Comparable recipient and graft survival rates between the study and control groups.
- Overall patient survival: 72% at 1 year, 72% at 5 years.
- Graft survival: 65% at 1 year, 65% at 5 years.
Conclusions:
- Liver transplantation from donors with bacterial meningitis is a safe procedure.
- Adequate antimicrobial therapy for both donors and recipients is crucial.
- Outcomes are comparable to standard liver transplantation protocols.
Background:
The shortage of suitable donors for transplantation is a worldwide problem. The use of cadaveric donors with bacterial meningitis may be associated with an increased risk of sepsis. We report the results of orthotopic liver transplantation (OLT) from 33 such donors between 1989 and 1999.
Methods:
The hospital records of recipients from cadaveric donors with meningitis (study group) were retrospectively reviewed and compared with matched recipients from cadaveric donors dying from causes other than meningitis (recipient-matched control group).
Results:
A total of 34 recipients underwent 21 whole, 10 reduced, and 3 split liver transplants from 33 cadaveric donor livers with bacterial meningitis. The donor meningitis pathogens were Neisseria meningitidis (n=14), Streptococcus pneumoniae (n=4), Haemophilus influenzae (n=1), Streptococcus species (n=2), and unknown (n=12). Twenty-seven patients had an elective OLT and seven patients had an emergency OLT. Adequate antimicrobial therapy before organ procurement and after transplant was administrated. The mean posttransplant follow-up was 37 months (range: 1 day-106 months). There was no difference in recipient and graft survival rates between the study and the recipient-matched groups. In the study group, there were no infectious complications caused by the meningeal pathogens. Overall patient survival rates were 79%, 76%, 72%, and 72% at 1, 6, 12, and 60 months, respectively. Graft survival was 77%, 70%, 65%, and 65% at 1, 6, 12, and 60 months, respectively. The survival rate in elective cases was significantly better than emergency cases (P<0.05).
Conclusion:
Liver transplantation from donors with bacterial meningitis is a safe procedure provided both donors and recipients receive adequate antimicrobial therapy.