Clinical impact of preservation fluid contamination on kidney transplant patients

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.

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).

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.

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.