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Qureshi S, Elliott H, Noel A, Swift L, Fear C, Webster R, Brown NM, Gaurav R, Butler AJ, Watson CJE. Infection and Prophylaxis During Normothermic Liver Perfusion: Audit of Incidence and Pharmacokinetics of Antimicrobial Therapy. Transplantation 2024; 108:1376-1382. [PMID: 38196099 PMCID: PMC11115456 DOI: 10.1097/tp.0000000000004897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/23/2023] [Accepted: 10/01/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Ex situ normothermic liver perfusion (NMP) in a blood-based perfusate is associated with a risk of microbe growth, resulting in life-threatening posttransplant sepsis. Antibiotics are widely used, but the pharmacokinetics of these agents are unknown as is their efficacy. We wished to assess the perfusate concentrations of the meropenem and fluconazole that we use and to audit the incidence of infection with this antimicrobial therapy. METHODS Fluconazole and meropenem (100 mg each) were added to the perfusate before NMP began, and serial samples were taken and assayed for drug concentrations. Perfusate cultures were available from 210 of the 242 perfusions performed between February 1, 2018, and April 6, 2023; these were reviewed. RESULTS Following administration of 100 mg fluconazole, levels fell slightly from a median of 24.9 mg/L at 1 h to 22.6 mg/L at 10 h. In contrast, meropenem concentrations fell over time, from a median of 21.8 mg/L at 1 h to 9.4 mg/L at 10 h. There were 4 significant microorganisms grown in the perfusions, including 3 Candida species and an Enterococcus faecium . All the Candida -infected livers were transplanted with no adverse consequences, the recipients being treated with anidulafungin upon identification of the infecting organism; the Enterococcus -infected liver was not transplanted. CONCLUSIONS Serious infection is a risk with NMP but appears to be mitigated with a protocol combining fluconazole and meropenem. This combination may not be appropriate in areas where resistance is prevalent. Routine culture of NMP perfusate is essential to identify breakthrough organisms early and enable recipient treatment.
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Affiliation(s)
- Saeed Qureshi
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Heather Elliott
- Antimicrobial Reference Laboratory, Pathology Sciences Building, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Alan Noel
- Antimicrobial Reference Laboratory, Pathology Sciences Building, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - Lisa Swift
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Corrina Fear
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Rachel Webster
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Nicholas M Brown
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Rohit Gaurav
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Andrew J Butler
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
- The Cambridge NIHR Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Cambridge, United Kingdom
| | - Christopher J E Watson
- The Roy Calne Transplant Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, United Kingdom
- The Cambridge NIHR Biomedical Research Centre and the NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Cambridge, United Kingdom
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Picola Brau N, Fiol Riera M, Etcheverry Giadrosich B, Riera Canals L, Melilli E, Sabé Fernández N, Castells Esteve M, Vigués Julià F. Clinical impact of preservation fluid contamination on kidney transplant patients. Transpl Infect Dis 2024; 26:e14208. [PMID: 38071458 DOI: 10.1111/tid.14208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/31/2023] [Accepted: 11/19/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Kidney 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. METHODS We 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). RESULTS Of 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. CONCLUSION The 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.
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Affiliation(s)
| | - Maria Fiol Riera
- Urology Service, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Edoardo Melilli
- Nephrology Service, Bellvitge University Hospital, Barcelona, Spain
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Zhang X, Shan H, Zhang M, Yang H, Gu L, Mi Z, Wang X, Wang Y, Tang Z, Shan H, Zhang X. Donor-Derived Infection's Prevention and Control in Kidney Transplantation. Transplant Proc 2023; 55:22-29. [PMID: 36682943 DOI: 10.1016/j.transproceed.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/07/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The study aimed to summarize the experience of donor selection and recipient therapy in the face of potential donor-derived infections and improve the quality of donor organ utilization, which would help reduce the risk of infection after recipient operation and decrease the risk of loss or even death of recipient kidney transplantation. METHODS In this study, 132 kidneys from 70 donors and their recipients who underwent surgery between July 2017 and January 2021 were studied to perform a retrospective analysis of their etiologic examination results and treatment process. RESULTS In the 70 donors, only 25 had negative etiologic examination results, accounting for 35.71%. Among the 132 recipients, 31.82% had positive culture results, 3 (2.27%) experienced donor-derived infections, and one died. CONCLUSIONS Although infection in the donor before the donation is quite common, the incidence of donor-derived infections is relatively low. The targeted and preventive application of adequate sensitive antibiotics in the whole course of therapy was the cornerstone for treating recipients at potential risk of potential donor-derived infection. The changes in infection indicators in the recipient should be closely monitored, which would guide medication adjustments timely. These measures could, to a great degree, ensure the prognosis of the recipient, in turn reducing the adverse events caused by donor-derived infections.
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Affiliation(s)
- Xin Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China
| | - Hui Shan
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China
| | - Min Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China
| | - Hui Yang
- Department of Pharmaceuticals, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Gu
- Department of Infectious Disease, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zixin Mi
- Department of Organ Procurement Organizations Office, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuezhu Wang
- Department of Organ Procurement Organizations Office, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yaping Wang
- Department of Organ Procurement Organizations Office, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ziren Tang
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Shan
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China.
| | - Xiaodong Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China.
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4
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Candida Contamination in Kidney and Liver Organ Preservation Solution: Does It Matter? J Clin Med 2021; 10:jcm10092022. [PMID: 34065096 PMCID: PMC8125956 DOI: 10.3390/jcm10092022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Fungal infections remain a major challenge affecting outcomes after kidney (KT) and liver transplantation (LT). METHODS In this retrospective single center study, the incidence of Candida contamination in renal and hepatic graft preservation solution (PS) was evaluated. In addition, Candida associated infections in recipients and related complications were analyzed. RESULTS Overall, the PS of 1248 hepatic and 1273 renal grafts were evaluated. The incidence of fungal contamination in the PS of hepatic and renal grafts was 1.2% and 0.86%, respectively. Additionally, the hepatic PS of one patient who underwent a combined liver-kidney transplant had Candida contamination. Candida albicans was the most common organism (70.4%) and 65.4% of the patients received antifungal treatment. Candida-associated complications in the recipients was 19%. Complications in LT patients included Candida peritonitis and Candida sepsis. Two KT recipients with contaminated PS developed a mycotic aneurysm at the anastomotic site resulting in severe bleeding. The 1-year mortality in patients with PS contamination for LT and KT recipients was 33% and 18%, respectively. Although the incidence of fungal contamination of PS was low, contaminated PS was associated with a high mortality. CONCLUSION The results of the study suggest that PS should be evaluated for fungal growth.
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5
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Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients. Intensive Care Med 2019; 45:573-591. [PMID: 30911807 PMCID: PMC7079836 DOI: 10.1007/s00134-019-05597-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
Purpose Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality. Methods Narrative review. Results We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population. Conclusion We provide state-of the art review of available knowledge of critically ill SOT patients with infections.
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Manuel O, Ison MG. Prevention and Treatment of Yeast and Endemic Fungal Infections. INFECTIOUS DISEASES IN SOLID-ORGAN TRANSPLANT RECIPIENTS 2019. [PMCID: PMC7138456 DOI: 10.1007/978-3-030-15394-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive fungal infections (IFIs) remain an important complication of solid organ transplantation owing to their significant morbidity and mortality and include infections due to Candida, Cryptococcus, endemic mycosis, and other rare yeasts and molds. IFIs occur in different intervals posttransplantation and depend on a number of extrinsic and intrinsic risk factors, some of which are specific to the type of organs transplanted, surgical techniques, and type of immunosuppressive medications. Donor-derived IFIs and emergence of new multidrug-resistant yeasts have been reported in various healthcare settings. Clinical manifestations of yeast and endemic fungal infections vary in different types of organ transplants. Diagnosis of IFIs in SOT recipients is challenging due to their nonspecific signs and symptoms owing to the impaired inflammatory responses as a result of immunosuppression and the lack of highly sensitive and specific diagnostic modalities. Early diagnosis is key to successful therapy, and physicians should have a high index of suspicion based on risk factors and epidemiology of these pathogens. Antifungal treatment strategies for yeast infections have been outlined in various society guidelines. Management of complications that arise before or during antifungal therapy is critical for optimizing clinical response.
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Affiliation(s)
- Oriol Manuel
- Infectious Diseases Service and Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael G Ison
- School of Medicine, Northwestern University Feinberg, Chicago, IL USA
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Teh YE, Ang MLT, La MV, Gunalan V, Tan CK, Tan AL, Lin RTP, Tan TT, Jeyaraj PR, Cumaraswamy S, Tan BH. Donor-Derived Candida dubliniensis Resulting in Perigraft Abscesses in a Liver Transplant Recipient Proven by Whole Genome Sequencing: A Case Report. Transplant Proc 2018; 50:915-919. [PMID: 29661462 DOI: 10.1016/j.transproceed.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The transmission of fungi via transplant, although well-known, has not often been molecularly proven. We describe a case of donor-derived candidiasis verified by whole genome sequencing. CASE DESCRIPTION The multiorgan donor was a 42-year-old woman with subdural hemorrhage. Procurement of the thoracic organs was performed followed by the abdominal organs. Tissue from the left bronchus grew Candida dubliniensis. The liver recipient was a 63-year-old woman with cryptogenic liver cirrhosis. She was noted to have worsening leukocytosis on postoperative day (POD) 9. Computed tomography of the abdomen and pelvis showed multiple rim-enhancing collections around the graft. Percutaneous drainage was performed. Fluid cultures grew C dubliniensis. C dubliniensis isolated from the donor's left bronchus and the liver recipient's abscesses were verified to be related by whole genome sequencing. We postulate that C dubliniensis colonizing the donor's transected trachea could have contaminated the inferior vena cava when the former was left open after explant of the donor's lungs. A portion of the donor's contaminated inferior vena cava was transplanted along with the liver graft, resulting in the infected collections in the recipient. CONCLUSIONS Our case report highlights the importance of maintaining a sterile field during organ procurement, especially in a multiorgan donor whose organs are explanted in succession.
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Affiliation(s)
- Y E Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - M L T Ang
- National Public Health Laboratory, Ministry of Health, Singapore
| | - M V La
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - V Gunalan
- Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - C K Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - A L Tan
- Department of Microbiology, Singapore General Hospital, Singapore
| | - R T P Lin
- National Public Health Laboratory, Ministry of Health, Singapore; Department of Laboratory Medicine, National University Hospital, Singapore
| | - T T Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - P R Jeyaraj
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - S Cumaraswamy
- Heart and Lung Transplant Unit, Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - B H Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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8
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El-Bandar N, Kroy DC, Fuller TF, Kramer J, Liefeldt L, Budde K, Blobel C, Miller K, Friedersdorff F. Development of Graft-Site Candidiasis in 3 Solid Organ Transplant Recipients from the Same Donor. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:777-781. [PMID: 28694422 PMCID: PMC5518847 DOI: 10.12659/ajcr.904119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Case series Patient: Female, 61 • Female, 33 • Female, 58 Final Diagnosis: Candida arteritis Symptoms: Severe bleeding Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Nasrin El-Bandar
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
| | - Daniela C Kroy
- Department of Medicine III, RWTH University Hospital Aachen, Aachen, Germany
| | - Tom Florian Fuller
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
| | - Jürgen Kramer
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Conrad Blobel
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
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9
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Oriol I, Lladó L, Vila M, Baliellas C, Tubau F, Sabé N, Fabregat J, Carratalà J. The Etiology, Incidence, and Impact of Preservation Fluid Contamination during Liver Transplantation. PLoS One 2016; 11:e0160701. [PMID: 27513941 PMCID: PMC4981323 DOI: 10.1371/journal.pone.0160701] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
The role of contaminated preservation fluid in the development of infection after liver transplantation has not been fully elucidated. To assess the incidence and etiology of contaminated preservation fluid and determine its impact on the subsequent development of infection after liver transplantation, we prospectively studied 50 consecutive liver transplants, and cultured the following samples in each instance: preservation fluid (immediately before and at the end of the back-table procedure, and just before implantation), blood, and bile from the donor, and ascitic fluid from the recipient. When any culture was positive, blood cultures were obtained and targeted antimicrobial therapy was started. We found that the incidence of contaminated preservation fluid was 92% (46 of 50 cases of liver transplantation per year), but only 28% (14/50) were contaminated by recognized pathogens. Blood and bile cultures from the donor were positive in 28% and 6% respectively, whereas ascitic fluid was positive in 22%. The most frequently isolated microorganisms were coagulase-negative staphylococci. In nine cases, the microorganisms isolated from the preservation fluid concurred with those grown from the donor blood cultures, and in one case, the isolate matched with the one obtained from bile culture. No liver transplant recipient developed an infection due to the transmission of an organism isolated from the preservation fluid. Our findings indicate that contamination of the preservation fluid is frequent in liver transplantation, and it is mainly caused by saprophytic skin flora. Transmission of infection is low, particularly among those recipients given targeted antimicrobial treatment for organisms isolated in the preservation fluid.
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Affiliation(s)
- Isabel Oriol
- Department of Infectious Diseases, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail:
| | - Laura Lladó
- Liver Transplant Unit, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marina Vila
- Liver Transplant Unit, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Baliellas
- Liver Transplant Unit, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Fe Tubau
- Department of Microbiology, Hospital de Bellvitge, Institut d’investigació Biomèdica de Bellvitge, University of Barcelona, l’Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sabé
- Department of Infectious Diseases, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Fabregat
- Liver Transplant Unit, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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10
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Successful Kidney and Lung Transplantation From a Deceased Donor With Blunt Abdominal Trauma and Intestinal Perforation. Transplant Direct 2016; 2:e55. [PMID: 27500248 DOI: 10.1097/txd.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
Abstract
The number of organ donors is limited by many contraindications for donation and poor quality of potential organ donors. Abdominal infection is a generally accepted contraindication for donation of abdominal organs. We present a 43-year-old man with lethal brain injury, blunt abdominal trauma, and intestinal perforation. After withdrawal of life-sustaining treatment and circulatory arrest, a minilaparotomy confirmed abdominal contamination with intestinal content. After closure of the abdomen, organs were preserved with in situ preservation with an aortic cannula inserted via the femoral artery. Thereafter, the kidneys were procured via bilateral lumbotomy to reduce the risk of direct bacterial contamination; lungs were retrieved following a standard practice. There was no bacterial or fungal growth in the machine preservation fluid of both kidneys. All organs were successfully transplanted, without postoperative infection, and functioned well after 6 months. We hereby show that direct contamination of organs can be avoided with the use of in situ preservation and retroperitoneal procurement. Intestinal perforation is not an absolute contraindication for donation, although the risk of bacterial or fungal transmission has to be evaluated per case.
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11
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Levesque E, Paugam-Burtz C, Saliba F, Khoy-Ear L, Merle JC, Jung B, Stecken L, Ferrandiere M, Mihaila L, Botterel F. Fungal complications after Candida preservation fluid contamination in liver transplant recipients. Transpl Int 2015; 28:1308-16. [PMID: 26147662 DOI: 10.1111/tri.12633] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/07/2015] [Accepted: 06/18/2015] [Indexed: 12/14/2022]
Abstract
Donor-derived fungal infections can be associated with severe complications in transplant recipients. Donor-derived candidiasis has been described in kidney transplant recipients where contamination of the preservation fluid (PF) was a commonly proposed source. In liver transplantation, these fungal infections have been less explored. The aim of this study was therefore to determine the incidence and clinical relevance of Candida contamination of preservation fluid in the context of liver transplantation. A 5-year (2008-2012) retrospective multicentre study involving six French liver transplantation centers was performed to determine the incidence of Candida PF contamination. Postoperative clinical features, outcomes in recipients, and risk factors for Candida-related complications of liver transplantation were studied. Candida sp. was isolated from 28 of 2107 preservation fluid samples (1.33%). Candida albicans was the most common yeast (n = 18, 64%). Twenty-two recipients (78.5%) received antifungal therapy (echinocandins in 68%) for 7-37 days. Eight patients developed yeast-related complications (28.6%) including hepatic artery aneurysms (n = 6) and Candida peritonitis (n = 2). The 1-year mortality rate among patients after a yeast-related complication was 62.5%. The incidence of Candida PF contamination was low, but was associated with dramatic postoperative complications and high mortality. Close radiological follow-up may enable early recognition of the arterial complications associated with PF contamination by Candida.
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Affiliation(s)
- Eric Levesque
- Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France
| | - Catherine Paugam-Burtz
- Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.,Sorbonne Paris Cité, Univ Paris Diderot, Paris, France.,INSERM U773, CRB3, Paris, France
| | - Faouzi Saliba
- Hepato-Biliairy Centre - Liver ICU, Hôpital Paul Brousse, Villejuif, France
| | - Linda Khoy-Ear
- Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Jean-Claude Merle
- Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France
| | - Boris Jung
- Department of Critical Care Medicine and Anesthesiology, Saint Eloi Teaching Hospital, Montpellier, France.,INSERM U-1046, University Montpellier I, Montpellier II, Montpellier, France
| | - Laurent Stecken
- Intensive Care & Anesthesiology Department, CHU Bordeaux, Bordeaux, France
| | | | - Liliana Mihaila
- Microbiology Unit, G.H. Kremlin-Bicètre, Kremlin-Bicètre, France
| | - Francoise Botterel
- Mycology Unit - Microbiology Department, DHU VIC, EA Dynamyc UPEC-ENVA-GH Henri Mondor, Créteil, France
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