Is This Organ Donor Safe?: Donor-Derived Infections in Solid Organ Transplantation

The study aimed to summarize the experience of donor selection and recipient therapy in the face of potential donor-derived infections and improve the quality of donor organ utilization, which would help reduce the risk of infection after recipient operation and decrease the risk of loss or even death of recipient kidney transplantation.

In this study, 132 kidneys from 70 donors and their recipients who underwent surgery between July 2017 and January 2021 were studied to perform a retrospective analysis of their etiologic examination results and treatment process.

In the 70 donors, only 25 had negative etiologic examination results, accounting for 35.71%. Among the 132 recipients, 31.82% had positive culture results, 3 (2.27%) experienced donor-derived infections, and one died.

Although infection in the donor before the donation is quite common, the incidence of donor-derived infections is relatively low. The targeted and preventive application of adequate sensitive antibiotics in the whole course of therapy was the cornerstone for treating recipients at potential risk of potential donor-derived infection. The changes in infection indicators in the recipient should be closely monitored, which would guide medication adjustments timely. These measures could, to a great degree, ensure the prognosis of the recipient, in turn reducing the adverse events caused by donor-derived infections.

La supervivencia del paciente sometido a trasplante de órgano sólido (TOS) ha aumentado en los últimos años, debido a estrategias profilácticas y regímenes inmunosupresores más ajustados. A pesar de esto, las infecciones en el paciente sometido a TOS continúan siendo causa de enfermedad grave, fallo orgánico, complicaciones postrasplante y pérdida del injerto, con un aumento de la morbilidad y de la mortalidad de estos pacientes. El cribado previo en los candidatos a donantes y receptores es crucial para prevenir estas posibles infecciones e implementar estrategias preventivas. Cuando estos mecanismos fallan, la realización de un diagnóstico rápido y adecuado es vital para el comienzo del tratamiento antimicrobiano correcto y evitar las posibles complicaciones en el periodo postrasplante.

The survival of patients who undergo solid organ transplantation (SOT) has increased in recent years due to more targeted prophylactic strategies and immunosuppressive regimens. Despite this, infections in patients who undergo SOT continue to be a cause of severe disease, organ failure, post-transplantation complications, and graft loss, with an increase in the morbidity and mortality of these patients. Prior screening of donors and recipient candidates is crucial for preventing these possible infections and implementing preventative strategies. When these mechanisms fail, making a quick, appropriate diagnosis is vital for starting the correct antimicrobial treatment and avoiding possible complications in the post-transplantation period.

An autopsy represents a snapshot in time regarding all the processes and diagnoses occurring at the time of death. A hospital autopsy is usually centered around a specific clinical question whereas forensic autopsies are usually more comprehensive. In either case, findings often go far beyond simply determining or confirming the cause of death. So-called incidental (“non-fatal”) findings may be of great significance to the family, the justice system, public health, death certification agencies, health providers, and academia. It is incumbent on the pathologist to document all findings at autopsy.

The number of surviving liver allograft recipients is increasing almost exponentially. The quality and length of life is increasing but most recipients have reduced survival and quality of life compared with healthy matched individuals.

Causes of premature death include cardio and cerebrovascular disease, renal failure, graft failure, de novo malignancy and recurrent disease.

Follow-up is needed lifelong to ensure graft and patient health and ensure that complications are recognised and treated early. Immunosuppression is kept to the appropriate minimum and prophylactic interventions are given early, such as use of statins and tight control of blood pressure and blood sugar.

Recipients will require life-long follow-up, and this is placing an increasing burden on transplant units. Follow-up is best done by close collaboration between the Liver Transplant Unit, the local hospital and primary care team. Involvement of other health care practitioners, such as recipient coordinators, pharmacists, dermatologists and addiction specialists may improve outcomes.

Key to successful follow-up are agreed protocols and good communication between the recipients and all relevant health care providers.

Use of IT allows for better communication and will support use of video and telephone consultations in selected instances.

The most appropriate follow-up will depend on many factors, including logistic and geographic issues, local experience.

The provision of well-funded and supported registries at local, national and international levels will allow for improvements in management.