Clinical Outcomes of Kidney Transplant Recipients with Positive Perfusion Fluid Cultures: A Single Centre Retrospective Study

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Abstract

Introduction

Perfusion fluid has been developed to optimise the storage of organs for transplantation, however it acts as a culture medium for pathogenic bacteria. Although clinical practice in UK involves routine culture of perfusion fluid, there is a delay in identification of pathogens. We did a retrospective study to assess the value of transport fluid (TPF) in deceased donor renal transplant recipients.

Materials and Methods

173 patients who received renal transplants between January 2014 and October 2016 were included in the study. Electronic data base was used to record culture result of perfusion fluid, pathogen identified, antibiotics used, length of hospital stay and presence of septic complication in recipients.

Results

106 patients received DBD and 67 had DCD organs.54.3% (n=94) had a negative TPF culture (Cl 46.88-61.72) and 45.7% (n=79) had a positive TPF culture (CI 38.28-53.12).21% (n=36) were diabetic and 4.3% (n=6) had post transplantation diabetes mellites.

Results

Coagulase negative staphylococci was found in 55.7% all positive samples. E.Coli was the most common pathogenic bacteria found (10%, n= 8). 45.7% (n=43) with a negative TPF culture developed infection as compared with 32.9% (n=26) with a positive TPF.

Results

Recipients with delayed graft function (DGF) had an infection rate of 54.9% (n =51). Patients without DGF had infection rate of 32.8% (n=116). This association is not statically significant (p=0.07), it may warrant further investigations.

Results

Patients who received prophylactic antibiotic (based on TPF culture results) had similar length of hospital stay compared with patients not receiving antibiotics. Urinary tract was the commonest site of infection (50%).Patients with diabetic nephropathy or chronic pyelonephritis had higher rates of infection.

Conclusion

Positive TPF culture samples was not associated with higher rates of infection or DGF. The likelihood of infection was higher in diabetic patients. Length of hospital stay was not reduced by use of prophylactic antibiotic. We suggest that a decision to give antibiotic should be based on patient's clinical status and virulence of pathogens found. Further studies are needed to establish role of prophylactic antibiotics in preventing septic complication in recipients with positive TPF culture results.

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