Transplantation of contaminated kidneys : the utility of perioperative donor perfusate cultures
Mary Froehlich2, Abigail Cheng2, Chelsey Wongjirad1,2, Sunil K Patel1.
1UMC Center for Transplantation, University Medical Center of Southern Nevada, Las Vegas, NV, United States; 2Surgery, UNLV School of Medicine, Las Vegas, NV, United States
Purpose: To study the impact of routine perioperative donor perfusate cultures (DPC) of preservation fluid in preventing postoperative infections after potentially contaminated kidney transplantation.
Methods: We routinely send fluid obtained from the transport medium during static cold preservation or machine perfusion, for aerobic ,anaerobic and fungal cultures. We studied the outcomes of all kidneys transplanted January 1, 2020 to December 1, 2022. We performed a retrospective study, where we compared kidney transplant recipients who had a DPC ( Group A) with those that did not have cultures drawn (Group B). We also compared outcomes in DPC + recipients who received antibiotics within 48 hours of a positive culture and DPC- recipients. Data was analyzed from a report obtained by querying a transplant database for results of donor perfusate cultures. The charts were reviewed for antibiotic prophylaxis post exposure, surgical site infections(SSI) , bacteremia, reoperations, graft and patient survival.
A Chi-square analysis was performed to compare outcomes in the two groups. A p value of <0.05 was considered significant .
Results:
| Group A | Group B | p value | |
| Recipients(n) | 116 | 155 | |
| Positive DPC | 13(11.2%) | ||
| Antibiotic prophylaxis | 13 | 0 | |
| SSI | 2(1.7%) | 4(2.58%) | 0.63 |
| Rexploration | 5 | 3 | 0.25 |
| 1 year graft survival | 115/116 | 152/155 | 0.46 |
| 1 year patient survival | 115/116 | 153/155 | 0.29 |
| DPC+ | DPC- | p value | |
| Recipients(n) | 13 | 104 | |
| SSI | 1 (7.69%) | 2(1.9%) | 0.21 |
| Rexploration | 1(7.69%) | 5(4.8%) | 0.65 |
| 1 year death censored graft survival | 13/13(100%) | 103/104 (99%) | 0.72 |
| 1 year patient survival | 13/13 | 103/104(99%) | 0.72 |
Organisms isolated included Bacteroides, Parabacteroides, Enterococcus, Coagulase negative staphylococci, Clostridia, Klebsiella, Lactobacilli, MDR E. coli, Pseudomonas , Proteus and yeast Positive DPC was obtained in 13 of 116 (11.2%) samples tested. All recipients with positive cultures were treated with appropriate antibiotics. DPC -(1.9%) had the least SSI when compared to DPC+ treated with antibiotics (7.69%) and when cultures were not drawn ( 2.58%). The results however did not reach statistical significance.
Conclusions: Donor perfusate cultures help detect potential pathogens in 11% of kidney transplants. Potentially contaminated kidneys, can be safely transplanted with donor perfusate culture testing and targeted antibiotics.
