Risk of Donor-Derived Infections From Organ Donors Colonized or Infected With Multidrug-Resistant Gram-Negative Bacteria: A Systematic Review and Meta-Analysis.

BACKGROUND

The presence of multidrug-resistant Gram-negative (MDR-GN) organisms in solid organ transplantation (SOT) donors raises concerns regarding transplant safety.

METHODS

We searched PubMed and Scopus (2010-2025) for observational studies reporting donor-derived infections (DDI) among SOT recipients from donors with MDR-GN colonization or infection. A single-arm meta-analysis was performed. Subgroup analyses examined donor risk categories (high-risk, low-risk), organ types, pathogen groups, and donor culture sites. 90-day mortality was estimated for recipients at risk of donor-to-recipient transmission based on presence of MDR-GN DDI.

RESULTS

Twelve cohort studies with 457 recipients were included. The pooled attack rate of MDR-GN DDI was 29% (95%CI: 11%-49%). DDI occurred in 40% (95%CI: 20%-62%) of high-risk transplantations but was absent in low-risk scenarios (0%, 95%CI: 0%-1%). Transmission was associated with graft-relevant exposure, including preservation fluid positivity (58%, 95%CI: 23%-89%) and organ-specific cultures. 90-day mortality among recipients corresponding to donors with carriage of MDR-GN pathogens was 14% (95%CI: 6%-30%). Higher 90-day mortality was observed among recipients with evidence of MDR-GN DDI (49%, 95%CI: 12%-87%).

CONCLUSIONS

Although transmission from MDR-GN donors seems to increase the mortality of the recipients, it is highly context-dependent and primarily driven by graft-related anatomical exposure rather than MDR status alone.