Contamination of Preservation Fluid in Cadaveric Renal Transplantation


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Abstract

Infections in the early post-renal transplant period are generally donor- or recipient-derived, or associated with the surgical technique adopted.Infection due to contamination of the preservation fluid (PF) has an incidence between 2.2-38.7%, and it may become a major complication in the immediate post-transplant period.There is still no consensus on the clinical and bacteriological consequences of routine preservation fluid cultures.This presentation aims at describing the incidence and consequences of the results of preservation fluid cultures in renal transplantation.MethodsCadaveric donor renal transplantations, which were carried out during the 2015-2016 period and in which preservation fluid cultures were performed, were retrospectively analyzed. They were placed in BacT/Alert medium for initial growth, and subsequently in blood, Sabouraud and CLDE agars, in addition to Gram staining.ResultsRoutine preservation fluid (PF) cultures were performed in 72 renal transplant patients, and 43 (59.7%) were positive. The most frequently isolated agent was coagulase-negative staphylococcus in 10 samples (23.2%).In six PF(+) donors, cultures with a positive microbiological isolation were obtained, but only one correlated with the PF germ.Of the 43 positive cultures, early treatment was administered to 28 patients; the agents used were as follows: vancomicine 13 (46.42%), imipenem 7 (25%), both 3 (10.71%), trimethoprim/sulfamethoxazole 2 (7.4%), amphotericin 2 (7.4%) and fluconazole 1 (3.57%).Two PF(+) patients developed urinary tract infection with the same germ; both of them had received early treatment and evolved satisfactorily.ConclusionRoutine cultures of preservation fluids increase the detection of their contamination, and result in the prescription of early antibiotic treatments.This analysis shows the need for further studies to be able to determine whether the low incidence of infection-related complications in recipients is due to the low transmissibility of the agents recovered from PFs or to the use of early antibiotic treatments.In addition, the impact of colonization with multiresistant bacteria in treated recipients, along with the potential benefit of an early scheme, should be assessed.

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