Clinical impact of preservation fluid contamination on kidney transplant patients

BackgroundKidney transplantation is associated with a high risk of infectious complications due to immunosuppressive therapy. Although infections may be transmitted from donor to transplant recipient through contaminated preservation solution (PS), the clinical impact of this is not well-understood.MethodsWe retrospectively evaluated PS contamination rates in a series of 339 patients who underwent cadaveric renal transplant at our centre. All patients with a positive culture received targeted preemptive therapy (PET).ResultsOf the 339 PS samples, 136 (40.1%) were positive for a microorganism, mainly coagulase-negative staphylococci (CoNS; n = 89;60.5%), gram-negative bacilli (n = 31;21.1%), non-CoNS gram-positive cocci (n = 18;12.2%), and Candida spp (n = 2;1.4%). Of the 136 positive cases, 42 (30.9%) received PET (12.4% of the cohort). No cases of urinary tract infection, surgical site infection, or graft loss were observed. Overall, our findings indicate that PS contamination, mainly by saprophytic skin flora (CoNS) is common. Only 8% of patients required antibiotic or antifungal therapy.ConclusionThe infection transmission rate from donors to recipients was negligible (0%), perhaps due to the early initiation of a targeted PET after isolation of a recognized pathogen. More data from large, prospective studies are needed to confirm these findings.image Routine preservation solution (PS) culture and early collection of blood and urine cultures in patients with positive PS are crucial to ensure the prompt diagnosis of PS-related infections, thus permitting early administration of the appropriate treatment.image

Automated summary

This study retrospectively evaluated the contamination rate of preservation solution in patients who underwent cadaveric renal transplant and found common microbial contamination. However, the risk of infection transmission from donor to recipient was minimal, possibly due to early targeted preemptive therapy.