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Donor-derived bacteremia in liver transplant recipients despite antibiotic prophylaxis

K E Doucette1, M Al-Saif1, N Kneteman2

  • 1Transplant Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|February 13, 2013
PubMed

Insights

Marginal organ donors, including those with bacteremia, pose infection risks. Even with antibiotic prophylaxis, transmission occurred in liver transplant recipients, suggesting higher risk for these patients.

Area of Science:

  • Transplantation Medicine
  • Infectious Diseases
  • Organ Donation

Background:

  • Increasing organ donor shortages lead to the use of marginal donors, including those with bacteremia.
  • Bacteremic donors pose a risk of transmitting infections to organ recipients.
  • Standard practice involves antibiotic prophylaxis for recipients of organs from bacteremic donors.

Observation:

  • Four cases of donor-derived bacteremia were observed in liver transplant recipients despite appropriate antimicrobial prophylaxis.
  • Transmitted pathogens included Staphylococcus aureus, Escherichia coli, and Group B Streptococcus.
  • No transmissions occurred in recipients of non-hepatic organs from the same bacteremic donors.

Findings:

  • Antimicrobial therapy in donors and recipients does not eliminate the risk of pathogen transmission from bacteremic donors.
  • Liver transplant recipients appear to be at a higher risk for developing donor-transmitted bacteremia.
  • The efficacy of current prophylaxis strategies against donor-derived bacteremia requires further investigation.

Implications:

  • Current prophylactic strategies may be insufficient to prevent all instances of donor-derived bacteremia in liver transplant recipients.
  • Further research is needed to refine donor screening and recipient management protocols for marginal organ donors.
  • Consideration of alternative or augmented prophylactic regimens may be warranted for liver transplant recipients receiving organs from bacteremic donors.

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