Safe Use of Infected Donor Organs in Kidney Transplantation

Organ availability is limited in the face of the growing number of candidates. Using organs from individuals with an infection at the time of transplantation emerged as a possible but controversial solution.

Retrospective analysis of patients submitted to kidney transplantation in Hospital Garcia de Orta (Almada, Portugal) from January 2008 to March 2019, comparing outcomes between recipients of organs from donors with an active infection and noninfected donors in the referred interval.

An active infection in the donor was identified in 55 cases (28.4%) from a total of 194 transplants. The most frequent site of infection was the lung (n = 30), followed by the urinary tract (n = 13); 9 donors (16.4%) had documented bacteremia. None of the identified microorganisms were multidrug-resistant. All recipients from an infected donor received adequate antibiotic prophylaxis (mean duration of 11.1 ± 3.0 days). No significant differences between groups were found regarding patients' demographics, cold ischemia time, duration of hospital stay, delayed graft function, rejection episodes, noninfectious complications, or patient and graft survival. Basiliximab was the preferred induction agent in both groups but was used in a larger proportion of recipients in the infected donor group (87.0% vs 60.6%; P = .001). The rate of infectious complications was significantly lower in the infected donor group (14.5% vs 42.4%; P = .001), and none of the previously isolated agents in the donor was found in the recipient.

Kidney transplant using infected donors can be performed safely, without worse organ-specific or recipient outcomes, if certain conditions are considered.