The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
The Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Infect Dis. 2020 Mar 16;221(Suppl 2):S164-S173. doi: 10.1093/infdis/jiz591.
Information on possible donor-derived transmission events in China is limited. We evaluated the impacts of liver transplantation from infected deceased-donors, analyzed possible donor-derived bacterial or fungal infection events in recipients, and evaluated the etiologic agents' characteristics and cases outcomes.
A single-center observational study was performed from January 2015 to March 2017 to retrospectively collect data from deceased-donors diagnosed with infection. Clinical data were recorded for each culture-positive donor and the matched liver recipient. The microorganisms were isolated and identified, and antibiotic sensitivity testing was performed. The pathogens distribution and incidence of possible donor-derived infection (P-DDI) events were analyzed and evaluated.
Information from 211 donors was collected. Of these, 82 donors were infected and classified as the donation after brain death category. Overall, 149 and 138 pathogens were isolated from 82 infected donors and 82 matched liver recipients, respectively. Gram-positive bacteria, Gram-negative bacteria, and fungi accounted for 42.3% (63 of 149), 46.3% (69 of 149), and 11.4% (17 of 149) of pathogens in infected donors. The incidence of multidrug-resistant bacteria was high and Acinetobacter baumannii was the most concerning species. Infections occurred within the first 2 weeks after liver transplantation with an organ from an infected donor. Compared with the noninfection recipient group, the infection recipient group experienced a longer mechanical ventilation time (P = .004) and intensive care unit stay (P = .003), a higher incidence of renal dysfunction (P = .026) and renal replacement therapy (P = .001), and higher hospital mortality (P = .015). Possible donor-derived infection was observed in 14.6% of cases. Recipients with acute-on-chronic liver failure were more prone to have P-DDI than recipients with other diseases (P = .007; odds ratio = 0.114; 95% confidence interval, .025-.529).
When a liver recipient receives a graft from an infected deceased-donor, the postoperative incidence of infection is high and the infection interval is short. In addition, when a possible donor-derived, drug-resistant bacterial infection occurs, recipients may have serious complications and poor outcomes.
中国关于供体来源传播事件的信息有限。我们评估了来自感染的已故供体的肝移植的影响，分析了受者中可能的供体来源细菌或真菌感染事件，并评估了病原体的特征和病例结果。
2015 年 1 月至 2017 年 3 月进行了一项单中心观察性研究，回顾性收集了诊断为感染的已故供体的数据。为每位培养阳性供体和匹配的肝受体记录临床数据。分离和鉴定微生物，并进行抗生素敏感性试验。分析和评估了病原体分布和可能的供体来源感染（P-DDI）事件的发生率。
共收集 211 名供体的信息。其中，82 名供体感染，分为脑死亡后捐献类别。总体而言，从 82 名感染供体和 82 名匹配的肝受体中分别分离出 149 和 138 种病原体。感染供体中的病原体分别为革兰氏阳性菌、革兰氏阴性菌和真菌占 42.3%（63/149）、46.3%（69/149）和 11.4%（17/149）。耐多药细菌的发生率较高，鲍曼不动杆菌是最令人关注的物种。肝移植后 2 周内发生感染，供体器官来自感染供体。与非感染受体组相比，感染受体组的机械通气时间（P =.004）和重症监护病房停留时间（P =.003）较长，肾功能障碍（P =.026）和肾脏替代治疗（P =.001）的发生率较高，且住院死亡率（P =.015）较高。观察到 14.6%的病例存在可能的供体来源感染。与其他疾病的受体相比，患有慢性肝衰竭急性发作的受体更容易发生 P-DDI（P =.007；比值比= 0.114；95%置信区间，0.025-0.529）。
当肝受体接受来自感染已故供体的移植物时，术后感染的发生率高，感染间隔短。此外，当发生可能的供体来源、耐药细菌感染时，受者可能会出现严重并发症和不良结局。
