Expanding the donor pool--preliminary outcome of kidney recipients from infected donors

The number of cadaver donors is far beyond demand. The use of marginal donors may increase the number of organs available for transplantation.

We expanded our criteria for cadaver donors to include those with active infections. From January 2004 through August 2005, there were 25 cadaveric transplantations in our center. Infected donors accounted for 13 transplants and the remaining 12 that were not infected were used as the control subjects. Blood and infected locus cultures were performed before transplantation and the recipients were treated accordingly.

There were no statistically significant differences between post-transplantation creatinine levels of the kidneys from infected and non-infected donors at 1 month (1.50 +/- 0.61 vs 2.21 +/- 0.77, p = 0.235) and 3 months (1.33 +/- 0.57 vs 2.31 +/- 0.92, p = 0.311) after transplantation. There were no differences in final creatinine levels (1.25 +/- 0.39 vs 1.81 +/- 0.89, p = 0.077), urinalysis white blood cell count (11.62 +/- 26.64 vs 1.91 +/- 3.30, p = 0.102) and blood white cell count (7677 +/- 1890 vs 8636 +/- 2390, p = 0.635). None of the recipients in the infected donor group developed systemic infections or complications. Graft and patient survival rates were both 100%.

Our results seem to suggest that kidneys procured from infected donors might be suitable for transplantation without transmission of the infective organism. Nevertheless, prophylactic antibiotics, close monitoring for possible infection and great care are warranted to prevent related complications. However, longer follow-up periods are needed.