Bacterial translocation in deceased organ donors

Objective: to ascertain the prevalence and risk factors for bacterial translocation (BT) in brain-dead donors (BDDs) during organ and tissue retrieval in health care facilities.

Materials and methods. The study included 62 BDDs, featuring 44 males (71%) and 18 females (29%), aged 17 to 64 years. Organ was retrieved in healthcare institutions located in Gomel Oblast in 2019–2022. Bacteriological examination of biopsy material taken from different parts of the intestine, mesenteric lymph nodes (MLNs) and spleen was carried out. The presence of BT was validated when bacterial growth was obtained from homogenized MLNs and(or) spleen by isolating an identical strain from the intestinal lumen. The anthropometric characteristics of BDDs, hematologic, biochemical parameters, and the length of stay in the intensive care unit (ICU) were assessed.

Results. Evidence of bacterial translocation was detected in 22 BDDs (35.5%, 95% CI 24.7–48.0). Growth in MLNs and in spleen biopsies was noted in 21 (95.5%) and 7 (31.8%) patients, respectively. The BDDs were categorized into two groups depending on the presence of BT, and the main characteristics were compared. ROC analysis was used to determine the prognostic significance of the main parameters. Risk factors for BT were serum sodium level >144 mmol/L (AUC = 0.759) at the time of retrieval, weight >89 kg (AUC = 0.756), BMI >27.5 (AUC = 0.709), decreased hemoglobin <126 g/L (AUC = 0.665), and ICU stay >2 days (AUC = 0.656).

Conclusion. Bacterial translocation is found in 35.5% of BDD cases, and it is accompanied by penetration of bacteria and yeast-like fungi into the MLNs and spleen. Bacterial translocation is linked to excess body weight, hypernatremia, prolonged ICU stay, and decreased hemoglobin levels at the time of retrieval. These factors should be taken into account in the medical management of brain-dead donors (organ donor conditioning).

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