# The species, distribution, resistance of donor-derived pathogens and their impact on solid organ transplant recipients

## TL;DR

This study shows that multidrug-resistant pathogens in deceased donors can lead to infections in organ transplant recipients, and using mNGS improves detection and outcomes.

## Contribution

The study demonstrates the effectiveness of mNGS in detecting donor-derived pathogens and its potential to improve transplant outcomes.

## Key findings

- 89.4% of donors had positive cultures for multidrug-resistant organisms.
- mNGS showed superior sensitivity and faster detection of pathogens compared to conventional culture.
- DDIs were associated with higher mortality and worse transplant outcomes.

## Abstract

Donor-derived infections (DDIs) have become a significant cause of infection in organ transplant recipients. Elaborating on the species, distribution, and resistance of donor-derived pathogens (DDPs) holds important implications.

A retrospective cohort study included 302 deceased donors and their corresponding 464 kidney transplant recipients and 175 liver transplant recipients. We detected DDPs in preservation fluid (PF) using both conventional culture and mNGS, and subsequently analyzed the incidence of DDIs after transplantation.

89.4% (270/302) of donors had positive cultures. Predominant multidrug-resistant organism included HLAR-Enterococcus, CRAB, CRKP, CRPA, MRS and ESBL-Escherichia coli. Compared with conventional culture, mNGS exhibited superior sensitivity for detecting bacteria and fungus in PF, with shorter turnaround time (p < 0.001). The incidences of DDIs in kidney and liver transplant recipients were 16.6% (77/464) and 19.4% (34/175) respectively. The recipients with DDIs were associated with elevated serum creatinine or total bilirubin levels, increased infection events, higher risks of graft loss, elevated mortality, and longer length of hospital stay (p < 0.05).

Multidrug-resistant organism are prevalent in deceased donors, with PF contamination primarily originating from donors. Integration of mNGS into donor screening protocols enables timely antimicrobial intervention, potentially improving transplant outcomes.