Translocation of bacteria and endotoxin in organ donors.

OBJECTIVE

To determine if bacterial translocation and endotoxin absorption occur in organ donors with an anatomically intact gastrointestinal tract.

DESIGN

Case series.

SETTING

Intensive care units in general and university hospitals.

PATIENTS: Twenty-one (multiple) organ donors.

INTERVENTION: None.

MAIN OUTCOME MEASURES: Occurrence of factors that may promote bacterial translocation and/or endotoxin absorption. Bacterial concentration in mesenteric lymph nodes, abdominal fluid, blood, liver, lung, and spleen. Endotoxin level in abdominal fluid, peripheral blood, and portal blood. Anatomical integrity of the bowel wall.

RESULTS

Factors that may promote bacterial translocation and/or endotoxin absorption were present in all organ donors. Culture specimens revealed bacteria in 14 organ donors (67%). In 210 (81%) of 260 culture specimens, the bacteria isolated were identical to those isolated from the bowel content, demonstrating bacterial translocation. Endotoxin was found in nine (53%) of 17 abdominal fluid samples, in four (19%) of 21 peripheral blood samples, and in two (10%) of 21 portal blood samples. Light- and electron-microscopic examination of the bowel wall showed no anatomical abnormalities.

CONCLUSION

Bacterial translocation and endotoxin absorption are frequent among organ donors and may adversely influence organ function in transplant recipients and other critically ill patients.