Preservation Fluid Bacteriology in Kidney Transplantation: Comparing Uncontrolled Donation After Circulatory Death...

Area of Science:

• Transplantation Immunology
• Microbiology
• Nephrology

Background:

• Infectious complications are a major concern in organ transplantation.
• Preservation fluid (PF) can be a source of microbial contamination.
• The clinical significance of positive PF cultures in kidney transplants, particularly from uncontrolled donation after circulatory death (uDCD) donors, requires further investigation.

Purpose of the Study:

• To compare the incidence and clinical implications of positive PF cultures in kidney transplants from uDCD and donation after brain death (DBD) donors.
• To assess the impact of PF contamination on post-transplant bacteremia and antibiotic use.

Main Methods:

• Prospective, single-center study of 497 kidney transplants (147 uDCD, 350 DBD).
• Systematic collection and culture of PF samples at transplantation.
• Monitoring of recipients for bacteremia within the first post-transplant week.
• Analysis guided by identified bacterial types for antibiotic treatment decisions.

Main Results:

• Positive PF cultures were significantly more frequent in uDCD (32.0%) versus DBD (13.7%) transplants (p < 0.001).
• Bacteremia rates were similar between uDCD (8.5%) and DBD (6.3%) recipients (p = 0.673), with no culture-concordant cases.
• Antibiotic administration rates were not significantly different between the groups.

Conclusions:

• Kidney transplants from uDCD donors exhibit higher rates of PF microbial contamination.
• Despite increased PF contamination, uDCD kidney transplantation is associated with comparable post-transplant bacteremia and clinical outcomes to DBD.
• The clinical impact of positive PF cultures in uDCD kidney transplants appears minimal.