Bacterial and Fungal Infections in Postoperative Liver Transplantation and Their Relationship with the Donor

Abstract

Introduction:  Nosocomial infections remain a significant cause of adverse outcomes following liver transplantation. Donor-derived infections (DDIs) are rare but potentially life-threatening in this context. Bacterial and fungal infections are among the most common forms of DDI. Given the shortage of organs and the high number of patients on the waiting list, it is crucial to determine whether the use of organs from donors with positive cultures is harmful or feasible. Objectives:  To evaluate the incidence and impact of general infections, of the use of positive-culture donors, and of DDIs on liver transplant outcomes. Methods:  This retrospective observational study was conducted at the Hospital Geral, Universidade de Campinas. Digital records of all transplant recipients from April 2021 to January 2024 were reviewed to identify positive cultures, records of infection at the time of positive culture, and donor cultures. DDI was considered present when patients developed infection by the same agent isolated from the donor, provided they had not been colonized before. Kaplan-Meier curves were used to define survival, with Breslow’s test for comparison between groups with or without infection and with or without positive donor cultures. Results:  Ninety liver transplants were performed in 86 patients. Among the 90 donors, nine (10%) had positive cultures, and four (4.4%) met the criteria for bloodstream infection. Among the recipients, 26 (30.2%) developed infections with positive cultures during the 60 days following liver transplantation. No infections in recipients were linked to donors. There was no difference in mortality between those who received livers from positive-culture donors and negative-culture donors. Additionally, no difference in mortality was observed between those who developed infections and those who did not. Intensive care unit length of stay was higher in recipients who developed infections. Conclusion:  Infections remain an important cause of postoperative morbidity among liver transplant recipients, justifying concern about DDIs. However, positive-culture donors might be suitable for transplantation when no evident sepsis is present at the time of organ harvest. The design of this study is limited, and therefore, it is imperative to confirm these findings with further prospective studies.