Impact of donor infections on outcome of orthotopic liver transplantation

Abstract

Infection occurs when microbial agents enter the host, either through airborne transmission or by direct contact of a substance carrying the infectious agent with the host. Human body fluids, solid organs, or other tissues often are ideal vectors to support microbial agents and can transmit infections efficiently from donor to recipient. In the case of blood transfusion and tissue transplantation, the main consequence of such a transmission is infection of the recipient. However, in the case of solid-organ transplantation, and particularly for liver transplantation, donor infections are not only transmitted to the recipient, the donor infection also may affect the donated liver's preservability and subsequent function in the recipient irrespective of the systemic consequences of the infection. In addition, solid organ recipients of infected organs are less able to respond to the infectious agent because of their immunosuppressive treatment. Thus, transmission of infections from organ donor to liver recipient represents serious potential risks that must be weighed against a candidate's mortality risk without the transplant. However, the ever-increasing gap between the number of donors and those waiting for liver grafts makes consideration of every potential donor, regardless of the infection status, essential to minimize waiting list mortality. In this review, we will focus on assessing the risk of transmission of bacterial, fungal, viral, and parasitic infectious agents from cadaveric liver donors to recipients and the effect such a transmission has on liver function, morbidity, and mortality. We will also discuss risk-benefit deliberations for using organs from infected donors for certain types of recipients. These issues are critically important to maximize the use of donated organs but also minimize recipient morbidity and graft dysfunction. (Liver Transpl 2003; 9:451-462.)

Trends in brain-dead organ donor characteristics: a 13-year analysis

“…Although florid septicemia and severe infections were a contraindication to organ donation, presence of an infectious source (bacteremia, fungemia) did not preclude organ donation candidacy. 24 Expanded criteria donors are defined as those aged 60 years or older, or older than 50 years with at least 2 of the following conditions: hypertension history, serum creatinine > 1.5 mg/dL, or death due to stroke, which are the crietria used by the United Organ Sharing Network (UNOS). 25 …”

Cytomegalovirus Infection in Liver Transplantation

“…Among the complications caused by CMV in transplanted patients increased long-term mortality and worsening graft survival are common [35][36][37]. Clinical disease caused by CMV is expressed by fever, malaise, myalgia, leukopenia (WBC less than 4.0000/mm 3 ), increased transaminases (hepatitis), pulmonary (pneumonitis) and/or gastrointestinal (colitis, gastritis, esophagitis) and fever being the most common manifestation, which can also occur with neurological symptomatology compatible with encephalitis but these are rarer [29,38,39].…”

“…During liver transplantation, primary infection tends to be more important as the CMV viremia may be limited to when virus replication is detected in peripheral blood or significant increase of specific antibodies without symptoms or viral syndrome presenting fever equal or greater than 38ºC, malaise, leukopenia, atypical lymphocytosis equal or less than 3-5% and thrombocytopenia [14,37,42,45,46]. Antiviral treatment controls the acute manifestation of the disease in most cases, but may not eradicate the CMV with recurrence reported in 26-31% of solid organ transplant recipients.. [14,36].…”

Immunizations and infectious diseases in pediatric liver transplantation

“…The best described examples of donorassociated infections are CMV and EBV. 8,9 Although the frequency of some donor-associated pathogens (eg, human immunodeficiency virus, hepatitis B, and hepatitis C) have decreased substantially with better diagnostic screening tests, 10 recent evidence now demonstrates donor-associated transmission of West Nile virus and rabies. 11,12 Because organs from a single donor often go to disparate sites, it is important for the recipient center to report back to the United Network for Organ Sharing any unusual infections that might possibly have come from the donor.…”