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Clinical Significance of Organ Preservation Fluid Cultures in Pediatric Abdominal Solid Organ Transplantation
Hassan A Jamal1,2, Yong K Kwon3, Pamela L Valentino4
1Division of Infectious Diseases, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.
Insights
Preservation fluid cultures (PFCs) in pediatric abdominal solid organ transplant (aSOT) recipients rarely indicated infection. Routine PFCs can identify pathogens and guide antibiotic therapy for pediatric transplant patients.
Area of Science:
- Transplant Surgery
- Pediatric Infectious Diseases
- Microbiology
Background:
- Data on preservation fluid cultures (PFCs) and their predictive value for posttransplant infections (PF-I) in pediatric patients are limited.
- Clinical guidelines lack uniformity regarding PFC collection and management of positive results in children.
- This study addresses the uncertainty surrounding PFC utility in pediatric abdominal solid organ transplant (aSOT) recipients.
Purpose of the Study:
- To evaluate the significance of PFC-positive status in pediatric aSOT recipients.
- To determine the incidence of PF-I in this population.
- To assess the clinical outcomes associated with PFC-positive status.
Main Methods:
- Retrospective study of pediatric aSOT recipients (2012-2024) with routine PFC collection.
- Chart review to collect data on posttransplant bacterial infections, rejection, reoperation, hospitalization, and mortality.
- PF-I defined as culture-concordant infection with positive PFC.
Main Results:
- PFCs were positive in 14.5% of 337 aSOT recipients; Coagulase-negative Staphylococci and Cutibacterium spp. were most common.
- Infectious complications were more frequent in PFC-positive patients (30.6% vs. 18.4%, p=0.049).
- Two PF-I episodes occurred (4.1% of positive PFCs) in infant liver recipients; PFC-positive patients had longer hospitalizations (18.4% vs. 8.7%, p=0.037).
Conclusions:
- PFC-positive status and PF-I were infrequent in pediatric aSOT recipients.
- Routine bacterial PFCs are valuable for identifying pathogenic organisms.
- PFC results can guide preemptive antibiotic therapy in pediatric transplant care.
Background:
Pediatric data on preservation fluid cultures (PFCs) and their ability to predict preservation fluid-related posttransplant infections (PF-I) remain uncertain. In addition, clinical guidelines do not provide uniform recommendations regarding when to obtain PFC or how to manage positive results, particularly for children. In this study, we aimed to evaluate PFC-positive status and PF-I in pediatric abdominal solid organ transplant (aSOT) recipients.
Methods:
We conducted a retrospective, single pediatric center study of aSOT-recipients between 2012 and 2024, where PFCs were obtained routinely. Data were collected via chart review and included prespecified outcomes such as posttransplant bacterial infections, allograft rejection, unexpected return to the operating room, prolonged hospitalization, and death within 30 days posttransplant. PF-I was defined as a culture-concordant infection in the setting of PFC-positive status.
Results:
Among 337 aSOT recipients, PFCs were positive in 49 patients (14.5%). Coagulase-negative Staphylococci and Cutibacterium spp. were the most isolated organisms (63%). Infectious complications were more frequent in patients with PFC-positive status (30.6% vs. 18.4%; p = 0.049). Two PF-I episodes (4.1% of PFC-positive status) were identified, both in infant liver transplant recipients, involving vancomycin-resistant Enterococcous and methicillin-sensitive Staphylococcus aureus. At 30 days after transplantation, a higher percentage of the PFC-positive group remained hospitalized (18.4% vs. 8.7%; p = 0.037), whereas of the proportion of rejection, reoperation, and mortality was similar.
Conclusions:
PFC-positive status and PF-I were uncommon in this cohort. The utility of routine bacterial PFC is primarily to identify the growth of organisms considered pathogenic and to guide preemptive antibiotic therapy.
