*Purpose: Due to limited organ availability, use of donors with positive bacterial cultures is common practice. One of the main concerns is transmission to the transplant recipient, a potentially severe complication, which can be mitigated by peri and post-operative antimicrobials. This study aims to describe outcomes in transplant recipients who received organs from deceased donors with positive bacterial or fungal cultures.

*Methods: We conducted a single-center retrospective review of donor cultures in newly transplanted kidney and liver transplant recipients from November 2018 to September 2019. All donors had blood and urine cultures collected prior to procurement. Respiratory cultures (sputum or BAL) were collected if lung donation was considered. CSF was collected if meningitis was suspected. All transplants received 3 doses of cefazolin for perioperative prophylaxis. In addition, one dose of metronidazole was given to liver recipients. All recipients were followed for 90 days post-transplant for bacterial or fungal transmission.

*Results: We reviewed 200 transplant recipients from 167 unique transplant donors. The donated organs for transplantation were 154 kidneys, 5 kidney-pancreas, 35 liver and 6 liver-kidney. Of all organ donors, 128 (76.6%) had at least one positive culture with 29/128 (22.7%) bacteremia, 85/115 (73.9%) respiratory, 22/128 (17.2%) urine, and 2/128 (1.6%) CSF. Perioperative antibiotic prophylaxis was modified to cover positive donor cultures in 39/165 (23.6%) of kidney (or combined organ) recipients and 7/35 (20%) of liver recipients. The majority of positive donor urine cultures (17/19) were treated in kidney transplant recipients for a median of 13.8 days (range 7-60) and 25/29 (86.2%) donor bacteremias were treated for a median of 14 days (range 5-43). No transplant recipient had modification of antibiotics to treat positive donor respiratory cultures. During follow up, microbiologically-documented bacterial or fungal infections occurred in 9/200 (4.5%) by day 30 and an additional 5/200 (2.5%) by day 90. No recipient deaths occurred in the first 90 days post-transplant. We identified three episodes (1.5%) of possible donor-derived infections in the first 30 days; two kidney recipients had urine culture positivity in the immediate post-transplant period with the same organism as the donor BAL (Candida albicans and Klebsiella pneumoniae respectively). The third patient had a positive urine culture with the same organism as isolated in donor urine (E.coli). All three infections were treated without complications.

*Conclusions: Despite a significant number of positive cultures, no proven donor-derived infections occurred. Therapy for positive donor respiratory cultures is not required in abdominal transplant recipients. Kidneys from donors with bacteremia and bacteriuria can be safely transplanted with appropriate modification of perioperative antibiotics to mitigate the risk of donor derived infection.

« Back to 2021 American Transplant Congress