The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Abstract

Background We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered “high risk” for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid–related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid–related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.

Candida Infections in Solid Organ Transplantation

“…However, a study by Oriol et al showed that pre-emptive therapy with high-risk preservation fluid contamination (defined as isolation of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. and/or Candida species) led to a decrease in the rate of infections [96]. In the cohort with contaminated high-risk preservation fluid with pre-emptive therapy, no complications were found versus a rate of 8.5% complications in the contaminated high-risk group without pre-emptive therapy.…”

“…Many of these infections are presumed to be secondary to preservation fluid contamination, which can occur prior to or at the time of organ procurement. The rates of preservation fluid contamination range from 9.5% up to 37%, although of those specifically due to Candida species range from 0.6% up to 4.1% [91][92][93][94][95][96]. C. albicans remains the most common species identified ranging from 25% up to 64% of all cases [93,95,96].…”

Surveillance of common infections in the early period after renal transplantation in a national center: 2014‐2017

“…Microbiological culture of perfusion fluids was performed in almost all cases. A recent nationwide study from France concluded that 24% of deceased donor perfusion fluid cultures were positive, while a multi‐center cohort study from Spain reported a prevalence of 62.5% . A previous study in our institution between 2007 and 2011 identified an overall perfusion fluid contamination rate of 7.2%, similar to the rates observed in 2014 and 2016 (9%).…”

Contaminação do líquido de preservação relacionado à sobrevida do receptor no transplante ortotópico de fígado: análise retrospectiva dos últimos 10 anos

“…Contudo, a presença de microrganismos na cultura do LP tem sido apontada como importante causa de infecções e mortalidade pós transplante, favorecidas pela imunossupressão desses pacientes, e embora tenha sido frequentemente atribuída ao órgão doado, especula-se que o mecanismo de contaminação ocorra nos processos entre a retirada do órgão do doador e a implantação no receptor (4). Tendo isso em vista, alguns centros de transplante realizam culturas intraoperatórias do LP para detectar a contaminação do órgão e melhorar o diagnóstico precoce e manejo de complicações relacionadas à infecção (4,5).…”