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Multidrug-resistant donor-derived infections in solid organ transplantation: a systematic review and meta-analysis of

Carolina Andrade Lopes1, Julia Ferreira Mari1, Edson Abdala2

  • 1Department of Infectious Diseases and Tropical Medicine, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.

Transplantation Reviews (Orlando, Fla.)
|August 21, 2026
PubMed
Abstract

Insights

Multidrug-resistant organisms (MDROs) in solid organ donors pose a significant transmission risk during transplantation. Positive preservation fluid cultures and donor screening are key to mitigating these rare but serious donor-derived infections.

Area of Science:

  • Transplantation immunology
  • Infectious diseases
  • Microbiology

Background:

  • Donor-derived infections (DDIs) from multidrug-resistant organisms (MDROs) are rare but severe complications in solid organ transplantation (SOT).
  • Limited data exists on the transmission risk and outcomes of MDROs from SOT donors to recipients.

Purpose of the Study:

  • To systematically review and analyze the transmission rates and risk factors for MDROs from SOT donors.
  • To identify predictors of DDI and mortality in SOT recipients following transplantation from MDRO-positive donors.

Main Methods:

  • A systematic review following PRISMA 2020 guidelines, including case reports, case series, and cohorts (1999-2025).
  • Meta-analyses of proportions and logistic regression models were used to identify factors associated with DDI and mortality.

Main Results:

  • 46 studies included 435 donors and 544 transplants; Carbapenem-resistant Enterobacterales were most common (38.9%).
  • Overall transmission rate was 26.6%, despite prophylaxis in 86.5% of high-risk recipients.
  • Positive preservation fluid cultures, high-risk donor cultures, and liver transplantation were associated with increased transmission; positive screening cultures and carbapenem-resistant Acinetobacter baumannii were associated with lower risk.

Conclusions:

  • MDROs in SOT donors are linked to substantial transmission rates.
  • Preservation fluid cultures for all SOT and respiratory cultures for lung transplants are crucial for predicting transmission.
  • Organ- and site-specific donor screening and surveillance are recommended to reduce MDRO transmission.
Keywords:
Acinetobacter baumanniiDonor-derived infectionsLiver transplantationLung transplantationPreservation fluid

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