Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2017; 23(31): 5809-5816
Published online Aug 21, 2017. doi: 10.3748/wjg.v23.i31.5809
Donor-derived infections among Chinese donation after cardiac death liver recipients
Qi-Fa Ye, Wei Zhou, Qi-Quan Wan
Qi-Fa Ye, Wei Zhou, Qi-Quan Wan, Department of Transplant Surgery, the Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Qi-Fa Ye, Department of Transplant Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
Author contributions: Ye QF contributed to the study design and data analysis; Zhou W enrolled the study patients, performed the data collection, and contributed to the data analysis; Wan QQ drafted the manuscript and contributed to the study design and data analysis; all authors read and approved the final manuscript.
Supported by the New Xiangya Talent Project of The Third Xiangya Hospital of Central South University, No. 20170311.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of The Third Xiangya Hospital of Central South University, Changsha, China (IRB No. 2017-S003).
Conflict-of-interest statement: All the authors declare they have no conflict of interest related to the manuscript.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qi-Quan Wan, MD, Associate Professor, Department of Transplant Surgery, the Third Xiangya Hospital of Central South University, No. 138, Tongzipo Road, Changsha 410013, Hunan Province, China. 13548685542@163.com
Telephone: +86-731-88618312 Fax: +86-731-88618312
Received: March 20, 2017
Peer-review started: March 23, 2017
First decision: June 5, 2017
Revised: June 27, 2017
Accepted: July 22, 2017
Article in press: July 24, 2017
Published online: August 21, 2017
Processing time: 151 Days and 12 Hours
Abstract
AIM

To investigate blood cultures of deceased donors and report the confirmed transmission of bacterial infection from donors to liver recipients.

METHODS

We retrospectively studied the results of blood cultures among our donation after cardiac death (DCD) donors and calculated the donor-derived bacterial infection rates among liver recipients. Study participants underwent liver transplantation between January 1, 2010 and February 1, 2017. The study involved a total of 67 recipients of liver grafts from 67 DCD donors. We extracted the data of donors’ and patients’ characteristics, culture results and clinical outcomes, especially the post-transplant complications in liver recipients, from electronic medical records. We analyzed the characteristics of the donors and the corresponding liver recipients with emphasis put on donor-derived infections.

RESULTS

Head trauma was the most common origin of death among our 67 DCD donors (46.3%). Blood taken prior to the procurement operation was cultured for 53 of the donors, with 17 episodes of bloodstream infections developing from 13 donors. The predominant organism isolated from the blood of donors was Gram-positive bacteria (70.6%). Only three (4.5%) of 67 liver recipients developed confirmed donor-derived bacterial infections, with two isolates of multidrug-resistant Klebsiella pneumoniae and one isolate of multidrug-resistant Enterobacter aerogenes. The liver recipients with donor-derived infections showed relation to higher crude mortality and graft loss rates (33.3% each) within 3 mo post transplantation, as compared to those without donor-derived infections (9.4% and 4.7%, respectively). All three liver recipients received appropriate antimicrobial therapy.

CONCLUSION

Liver recipients have high occurrence of donor-derived infections. The liver recipients with donor-derived multidrug-resistant Enterobacteriaceae infections can have good outcome if appropriate antimicrobial therapy is given.

Keywords: Liver transplant; Donation after cardiac death donor; Infection; Multidrug resistant; Bacteria; Transmission

Core tip: This study aimed to investigate blood cultures of donation after cardiac death (DCD) liver donors and report the confirmed transmission of bacterial infection from donors to liver recipients. The predominant organism isolated from the blood of donors was Gram-positive bacteria (70.6%). Only three (4.5%) of 67 liver recipients developed confirmed donor-derived bacterial infections, with two isolates of multidrug-resistant Klebsiella pneumoniae and one isolate of multidrug-resistant Enterobacter aerogenes. Our findings support that liver grafts from DCD donors with bloodstream infections owing to multidrug-resistant Enterobacteriaceae can be used if the donors and recipients receive appropriate antimicrobial therapy.