Donor-derived resistant Gram-negative infections vary by graft exposure in transplant meta-analysis

A systematic review and meta-analysis in Clinical Transplantation examined donor-derived infections among solid organ recipients whose donors had multidrug-resistant Gram-negative bacterial colonization or infection. Investigators searched PubMed and Scopus for observational studies published during 2010–2025 and included 12 cohort studies involving 457 recipients. The single-arm analysis assessed infection rates by donor risk category, organ type, pathogen group, and donor culture site, alongside 90-day mortality.

The pooled donor-derived infection rate was 29% (95% CI, 11%–49%). Rates were 40% (95% CI, 20%–62%) in high-risk transplantations and 0% (95% CI, 0%–1%) in low-risk scenarios. Transmission was associated with graft-relevant exposure, including positive preservation-fluid cultures, for which the pooled rate was 58% (95% CI, 23%–89%), and organ-specific cultures. Pooled 90-day mortality was 14% (95% CI, 6%–30%) among recipients of organs from donors carrying these pathogens and 49% (95% CI, 12%–87%) among recipients with documented donor-derived infection.

The findings suggest that graft-related anatomical exposure, rather than donor resistance status alone, is important when assessing transmission risk. However, the observational, single-arm design cannot establish that transmission caused increased mortality, and several estimates have wide confidence intervals. Only the abstract was available; definitions of high- and low-risk scenarios and details of antimicrobial management were not provided.