Clinical outcome of cadaveric renal allografts contaminated before transplantation

Abstract

Summary This analysis was performed to define the incidence of pretransplant microbial contamination of donor kidneys, and to assess the resultant morbidity including infections requiring therapy, and graft loss. Case records of all 638 renal allograft recipients patients transplanted in our centre during the period June 1990 to October 2000 were studied. All the recipients were given a single dose of intravenous antibiotics at the time of induction of anaesthesia. A total of 775 microbiology reports on perfusion fluid, kidney swabs and ureteric tissue were retrieved. Fifty‐eight of 638 (9.1%) patients were transplanted with a graft that showed preoperative contamination. 18 of these 58 patients (31%) subsequently required antibiotic treatment. Thirty of 32 patients who received kidney contaminated with skin flora had a benign course (i.e. no unexplained, no positive blood cultures or graft infection). By contrast, seven of nine recipients with grafts whose perfusion fluid yielded lactose fermenting coliforms (LFCs) required antibiotics and three of nine of them suffered graft loss as a result. Two of these patients had bacteraemia caused by LFC, and one died. Three of five patients with positive cultures due to yeast required treatment with antifungals. None of the four patients who had graft contaminated by Staphylococcus aureus became infected. One‐year 49/58 (85%) of these patients survived with functioning graft. Overall 1‐year patient survival was 53/55 (92%). These data suggest that contamination of renal allografts by LFCs or yeasts need to be treated preemptively before the onset of clinical manifestations. By contrast, contamination with skin contaminants does not pose a risk to the graft.

Low predictive value of positive transplant perfusion fluid cultures for diagnosing postoperative infections in kidney and kidney–pancreas transplantation

“…The overall contamination rate was 7.2%, similar to the 4.2–28% reported in previous studies 15. Several publications report yeasts in PF, 1.7–2.75%; our rate was lower at 0.8% 16 17.…”

Pancreas preservation fluid microbial contamination is associated with poor islet isolation outcomes - a multi-centre cohort study

“…Differences between published contamination rates may be explained by inconsistent use of iodine duodenum decontamination, proton‐pump inhibitors in the intensive care unit, and other variations in the retrieval and microorganism identification protocols. As a point of comparison, the rates of microbial contamination of the preservation medium for other organs are as follow: 9–57% for kidneys , in 27% to 62% for livers , in 45–64% for heart valves , in 29% for lungs , and in 14–29% for cornea . In the present study, we identified a majority of Gram‐positive bacteria namely Staphylococcus spp.…”

“…Therefore, a strict quality control process must be implemented. The existing literature describes variable rates of solid organ (kidney, liver, heart, lung, and cornea) transport media microbial contamination, ranging from 9% to 64% (median 41%) [6][7][8][9][10][11]. In comparison, pancreas preservation medium contamination rates were reported between 28% and 62% (median 31%) [12][13][14][15].…”

Clinical and microbial impact of screening kidney allograft preservative solution for bacterial contamination with high-sensitivity methods

“…There is no consensual definition of bacterial PS contamination in kidney transplantation. Previous studies have reported PS contamination in between 2.2% and 38.7% of tested samples . This variation could be explained by the lack of a proper definition and the use of various culture methods.…”

“…PS contamination is a common cause of early post‐transplant infection, with a reported incidence of 2.2–38.7%, and may be a major cause of early morbidity after transplantation. However, prophylactic antibiotic therapy seems to prevent early post‐transplant infection .…”