Donor-Derived Bacterial Infections in Deceased Donor Liver Transplantation: Reassessment of Risk in the Era of Marginal Grafts

Background: The shortage of available organs for liver transplant has, over time, led to the inclusion of donors at risk of transmitting bacterial infections. In Italy, depending on the severity of this risk, these organs are only allocated to patients in serious clinical conditions, consequently, their use in a shortage context is further restricted. Methods: We retrospectively analyzed a consecutive series of 194 liver transplants from deceased adult donors performed at our institute between 2019 and 2021 and performed a statistical comparison between 2 groups: recipients of livers with a risk of transmission of bacterial infection (BR group) vs recipients of livers with no risk (noBR group). Primary endpoints include 90-day and 1-year survival rates of recipients, and secondary endpoints focus on the incidence of complications of grade ≥3 according to Clavien-Dindo and donor-related infections. Results: Ninety-day and 1-year mortality in the BR vs noBR group was 5% vs 7% and 5% vs 14%, respectively. Major complications at 90 days occurred in 37% of the BR group vs 47% in the noBR group. No statistical differences were observed in the 2 recipient groups with respect to clinical outcomes. Cases of donor-derived infections also occurred in the noBR group. Conclusions: Organs at risk of transmitting bacterial infections have comparable outcomes to other organs when appropriate risk reduction strategies are implemented. It is necessary to remove restrictions on these organs, which are becoming increasingly common in our shortage context.