Donor-derived infections among Chinese donation after cardiac death liver recipients

Table 1 Characteristics of the 67 donation after cardiac death donors n (%)

Characteristic	Value
Age in years, median (IQR)	29.0 (19.0-44.0)
Sex
Male	55 (82.1)
Female	12 (17.9)
Origin of death
HT	31 (46.3)
Benign CNS tumor	18 (26.9)
CVA	15 (22.4)
Anoxia	2 (3.0)
Meningitis	1 (1.5)
China classification of donation
I	5 (7.5)
II	8 (11.9)
III	54 (80.6)
ICU stay in days, median (IQR)	5 (3.0-10.0)
Donors with positive culture	13
Blood culture, n/n
Donors with/without available results	53/14
Donors with appropriate antimicrobial use/all donors with positive blood culture results	10/13

CNS: Central nervous system; CVA: Cerebrovascular accident; DCD: Donation after cardiac death; HT: Head trauma; ICU: Intensive care unit; IQR, Interquartile range.

Table 2 Classification and percentage of organisms isolated from donors' bloodstream, n = 17

Organism	n (%)
Gram-positive bacteria	12 (70.6)
Staphylococcus aureus	3 (17.6)
Coagulase-negative staphylococci	9 (52.9)
S. epidermidis	4 (23.5)
S. hemolyticus	1 (5.9)
S. capitis	1 (5.9)
S. hominis	2 (11.8)
S. simulans	1 (5.9)
Gram-negative bacteria	3 (17.6)
Klebsiella pneumoniae	2 (11.8)
Acinetobacter baumannii	1 (5.9)
Fungi	2 (11.8)
Candida albicans	1 (5.9)
Candida parapsilosis	1 (5.9)

Table 3 Characteristics of donors and their corresponding liver recipients with donor-derived infections

Donor	Diagnosis	Blood culture result	Recipient (sex/age)	Underlying liver disease(s)	Culture result (specimen)/time to infection onset	Inappropriate antimicrobial/immunosuppressive therapy	Outcome
D1	Head trauma	Negative1	R12 (Female/48 yr)	Polycystic liver disease	K. pneumoniae (Blood and abdominal drainage fluid)/1 d	No/Pred	Patient death and graft loss
D2	Head trauma	Negative1	R23 (Male/38 yr)	Hepatocellular carcinoma and cirrhosis due to hepatitis B virus infection	K. pneumoniae (Blood and abdominal drainage fluid)/1 d	No/FK506 + Pred	Patient and graft survival
D3	Head trauma	Not available	R33 (Male/69 yr)	Heredofamilial amyloidosis	E. aerogenes (Blood)/3 d	No/FK506 + Pred	Patient and graft survival

¹Donors had a negative result of blood culture after being admitted to the intensive care unit, whereas they did not undergo blood culture within 10 d prior to organ procurement;

²Two kidney recipients of graft from the common donor, with this liver recipient having developed organ-space surgical site infection owing to Klebsiella pneumoniae within 20 d following the transplantation;

³One kidney recipient of graft from the common donor, with this liver recipient having also developed bloodstream infection owing to the same bacterium immediately after the transplantation.

Table 4 Comparison of post-liver-transplant complications in liver recipients with and without donor-derived infections

Complication	Episodes of complications in three liver recipients with donor-derived infections	Episodes of complications in 64 liver recipients without donor-derived infections
Infection	4	16
Pneumonia	1	7
Peritonitis	0	3
Bloodstream infection	3	5
Surgical site infection	0	1
Vascular complications	0	9
Portal vein thrombosis	0	1
Cerebral embolism	0	1
Hepatic artery thrombosis	0	1
Abdominal bleeding	0	5
Gastrointestinal bleeding	0	1
Biliary complications	3	2
Bile leakage	0	0
Biliary strictures	1	2
Stone formation	1	0
Bilomas	1	0
Recurrent tumor	0	6
Acute rejection	0	4
Graft-versus-host disease	0	2
Graft dysfunction	0	3
Adhesive ileus	0	1