The role of preemptive antimicrobial therapy in kidney recipients of urine-only positive donor cultures

Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission

Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor-derived infection (DDI) and the consequence of organ non-utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.

Prevention, diagnosis, and management of donor derived infections in pediatric kidney transplant recipients

Donor derived infections (DDIs) in pediatric kidney transplant recipients remain challenging to diagnose and can result in serious morbidity and mortality. This review summarizes the current guidelines and recommendations for prevention, diagnosis, and treatment of unexpected DDIs in pediatric kidney transplant recipients. We provide a contemporary overview of DDI terminology, surveillance, epidemiology, and recommended approaches for assessing these rare events with an emphasis on the pediatric recipient. To address prevention and risk mitigation, important aspects of donor and pediatric candidate evaluations are reviewed, including current Organ Procurement and Transplantation Network (OPTN) and American Society of Transplantation (AST) recommendations. Common unexpected DDI encountered by pediatric transplant teams including multi-drug resistant organisms, tuberculosis, syphilis, West Nile Virus, toxoplasmosis, Chagas disease, strongyloidiasis, candidiasis, histoplasmosis, coccidioidomycosis, and emerging infections such as COVID-19 are discussed in detail. Finally, we consider the general challenges with management of DDIs and share our experience with a novel application of next generation sequencing (NGS) of microbial cell-free DNA that will likely define a future direction in this field.

Safe Use of Infected Donor Organs in Kidney Transplantation

INTRODUCTION

Organ availability is limited in the face of the growing number of candidates. Using organs from individuals with an infection at the time of transplantation emerged as a possible but controversial solution.

MATERIALS AND METHODS

Retrospective analysis of patients submitted to kidney transplantation in Hospital Garcia de Orta (Almada, Portugal) from January 2008 to March 2019, comparing outcomes between recipients of organs from donors with an active infection and noninfected donors in the referred interval.

RESULTS

An active infection in the donor was identified in 55 cases (28.4%) from a total of 194 transplants. The most frequent site of infection was the lung (n = 30), followed by the urinary tract (n = 13); 9 donors (16.4%) had documented bacteremia. None of the identified microorganisms were multidrug-resistant. All recipients from an infected donor received adequate antibiotic prophylaxis (mean duration of 11.1 ± 3.0 days). No significant differences between groups were found regarding patients' demographics, cold ischemia time, duration of hospital stay, delayed graft function, rejection episodes, noninfectious complications, or patient and graft survival. Basiliximab was the preferred induction agent in both groups but was used in a larger proportion of recipients in the infected donor group (87.0% vs 60.6%; P = .001). The rate of infectious complications was significantly lower in the infected donor group (14.5% vs 42.4%; P = .001), and none of the previously isolated agents in the donor was found in the recipient.

CONCLUSION

Kidney transplant using infected donors can be performed safely, without worse organ-specific or recipient outcomes, if certain conditions are considered.