Volume 12 Issue 6
Nov.  2021
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Article Navigation >  ORGAN TRANSPLANTATION  > 2021  >  12(6): 700-706
Zhang Fei, Liao Guiyi. Effect of donor-derived infection on clinical prognosis of kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2021, 12(6): 700-706. doi: 10.3969/j.issn.1674-7445.2021.06.009
Citation: Zhang Fei, Liao Guiyi. Effect of donor-derived infection on clinical prognosis of kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2021, 12(6): 700-706. doi: 10.3969/j.issn.1674-7445.2021.06.009
shu

Effect of donor-derived infection on clinical prognosis of kidney transplant recipients

doi: 10.3969/j.issn.1674-7445.2021.06.009

  • Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei 230000, China

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  • Corresponding author: Liao Guiyi, Email: liaoguiyi2@sina.com
  • Received Date: 2021-07-02
  • Publish Date: 2021-11-15
    Abstract
  •   Objective  To evaluate the effect of donor-derived infection (DDI) on clinical prognosis of kidney transplant recipients.  Methods  Clinical data of 82 donors from donation after citizen's death and 148 kidney transplant recipients were retrospectively analyzed. According to the culture results of the lavage fluid of donor kidney, all recipients were divided into the lavage fluid culture of donor kidney positive group (positive group, n=92) and lavage fluid culture of donor kidney negative group (negative group, n=56). All recipients were assigned into the DDI group (n=19) and non-DDI group (n=129) according to whether they developed DDI or not. The distribution and composition ratio of positive strains in the lavage fluid of donor kidney were analyzed. The incidence of postoperative infection and other complications was assessed in the recipients. Perioperative conditions of the recipients were statistically compared between the DDI and non-DDI groups. The treatment efficacy and clinical prognosis of DDI recipients were evaluated.  Results  Among 148 recipients, 92 obtained positive culture results in the lavage fluid of donor kidney. A total of 131 pathogenic strains were isolated, including 41.2% (54/131) of Gram-positive cocci, 48.9% (64/131) of Gram-negative bacilli and 9.9%(13/131) of fungi. Among 148 recipients, 52 cases were infected. And 45% (41/92) and 20% (11/56) of the recipients were infected in the positive and negative group, respectively. Statistical significance was noted between two groups (P=0.002). Surgical site was the most common infection site in 52 infected recipients, followed by the urinary system. Nineteen recipients developed DDI with an incidence rate of 12.8% and fatality of 16%. Compared with the non-DDI recipients, DDI recipients had significantly higher graft loss rate and fatality, and longer postoperative hospital stay (all P < 0.05). Eight cases presented with carbapenem-resistant Klebsiella pneumoniae (CRKP) infection, after treatment with tigecycline and/or polymyxin and carbapenems, 3 cases died, and 3 underwent kidney graft resection. In the other 8 recipients with CRKP infection, 2 cases were treated with ceftazidime-avibactam (CAZ-AVI) alone, 3 treated with CAZ-AVI combined with carbapenems, and 3 initially treated with tigecycline combined with carbapenems followed by CAZ-AVI for salvage treatment. After corresponding treatment, the recipients achieved long-term survival.  Conclusions  DDI may lead to severe complications, while early specific antibacterial treatment plays a positive role.

     

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    • References(27)
  • [1]
    VIGARA LA, VILLANEGO F, CAZORLA JM, et al. Characteristics and evolution of renal transplant recipients infected by carbapenemase-producing Klebsiella pneumonia[J]. Transplant Proc, 2020, 52(2): 519-522. DOI: 10.1016/j.transproceed.2019.09.017.
    [2]
    WANG Y, LEI H, ZHANG Y, et al. Epidemiology of carbapenem-resistant Klebsiella pneumoniae bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis[J]. Antimicrob Resist Infect Control, 2018, 7: 66. DOI: 10.1186/s13756-018-0355-8.
    [3]
    CAMARGO JF. Donor-derived infections in solid organ transplant recipients: challenging the 30-day paradigm[J]. Transpl Infect Dis, 2017, 19(2). DOI: 10.1111/tid.12665.
    [4]
    CORBEL A, LADRIÈRE M, LE BERRE N, et al. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study[J]. Clin Microbiol Infect, 2020, 26(4): 475-484. DOI: 10.1016/j.cmi.2019.07.018.
    [5]
    RANGHINO A, DIENA D, SIMONATO F, et al. Clinical impact of bacterial contamination of perfusion fluid in kidney transplantation[J]. Springerplus, 2016, 5: 7. DOI: 10.1186/s40064-015-1658-3.
    [6]
    JASIAK-PANEK NM, WENZLER E, PATEL S, et al. A randomized, open-label pharmacokinetic trial of tacrolimus extended-release dosing in obese de novo kidney transplant recipients[J]. Clin Transplant, 2019, 33(8): e13640. DOI: 10.1111/ctr.13640.
    [7]
    RETICKER A, LICHVAR A, WALSH M, et al. The significance and impact of screening preservation fluid cultures in renal transplant recipients[J]. Prog Transplant, 2021, 31(1): 40-46. DOI: 10.1177/1526924820978608.
    [8]
    YU X, WANG R, PENG W, et al. Incidence, distribution and clinical relevance of microbial contamination of preservation solution in deceased kidney transplant recipients: a retrospective cohort study from China[J]. Clin Microbiol Infect, 2019, 25(5): 595-600. DOI: 10.1016/j.cmi.2018.12.040.
    [9]
    ORIOL I, SABÉ N, TEBÉ C, et al. Clinical impact of culture-positive preservation fluid on solid organ transplantation: a systematic review and Meta-analysis[J]. Transplant Rev (Orlando), 2018, 32(2): 85-91. DOI: 10.1016/j.trre.2017.11.003.
    [10]
    ORIOL I, SABE N, CÀMARA J, et al. The impact of culturing the organ preservation fluid on solid organ transplantation: a prospective multicenter cohort study[J]. Open Forum Infect Dis, 2019, 6(6): ofz180. DOI: 10.1093/ofid/ofz180.
    [11]
    何莉, 林栋栋, 刘晋宁, 等. 公民器官捐献供者感染现状与应对的回顾性研究[J]. 北京医学, 2019, 41(6): 472- 475. DOI: 10.15932/j.0253-9713.2019.06.009.

    HE L, LIN DD, LIU JN, et al. A retrospective study on the current situation and coping strategies of organ donor infection[J]. Beijing Med J, 2019, 41(6): 472-475. DOI: 10.15932/j.0253-9713.2019.06.009.
    [12]
    ORIOL I, LLADÓ L, VILA M, et al. The etiology, incidence, and impact of preservation fluid contamination during liver transplantation[J]. PLoS One, 2016, 11(8): e0160701. DOI: 10.1371/journal.pone.0160701.
    [13]
    赵纪强, 霍枫, 汪邵平, 等. 公民逝世后器官捐献肝移植保存液污染: 基于78例单中心对照研究[J]. 分子影像学杂志, 2019, 42(4): 538-543. DOI: 10.12122/j.issn.1674-4500.2019.04.27.

    ZHAO JQ, HUO F, WANG SP, et al. Single-center analysis on preservation solution contamination and initial experience of liver transplantation from organ donation by citizens after death[J]. J Mol Imaging, 2019, 42(4): 538-543. DOI: 10.12122/j.issn.1674-4500.2019.04.27.
    [14]
    AL MIDANI A, HOOKHAM L, BANGA N, et al. The value of perfusion fluid culture analysis in deceased donor renal transplants: a 10-year single-center experience[J]. Transplant Proc, 2021, 53(6): 1808-1812. DOI: 10.1016/j.transproceed.2021.03.023.
    [15]
    郭琛, 刘剑, 纪建磊, 等. 供肾保存液的培养结果分析及临床意义[J]. 中华器官移植杂志, 2018, 39(10): 602-605. DOI: 10.3760/cma.j.issn.0254-1785.2018.10.006.

    GUO C, LIU J, JI JL, et al. Analysis and clinical significance of culture results of donor renal perfusate[J]. Chin J Organ Transplant, 2018, 39(10): 602-605. DOI: 10.3760/cma.j.issn.0254-1785.2018.10.006.
    [16]
    GRĄT M, LIGOCKA J, LEWANDOWSKI Z, et al. Incidence, pattern and clinical relevance of microbial contamination of preservation fluid in liver transplantation[J]. Ann Transplant, 2012, 17(3): 20-28. DOI: 10.12659/aot.883454.
    [17]
    MEIER RPH, ANDREY DO, SUN P, et al. Pancreas preservation fluid microbial contamination is associated with poor islet isolation outcomes - a multi-centre cohort study[J]. Transpl Int, 2018, 31(8): 917-929. DOI: 10.1111/tri.13159.
    [18]
    SOTIROPOULOS GC, KOSTAKIS ID, PRODROMIDOU A, et al. Contamination of the preservation solution in solid organ transplantation[J]. Transplant Proc, 2019, 51(2): 392-395. DOI: 10.1016/j.transproceed.2019.01.070.
    [19]
    WANG Z, QIAN Y, BAI H, et al. Allograft hemorrhage as a manifestation of carbapenem-resistant Klebsiella pneumonia infection in kidney transplant recipients: case series[J]. Medicine (Baltimore), 2020, 99(13): e18982. DOI: 10.1097/MD.0000000000018982.
    [20]
    YE QF, ZHOU W, WAN QQ. Donor-derived infections among Chinese donation after cardiac death liver recipients[J]. World J Gastroenterol, 2017, 23(31): 5809-5816. DOI: 10.3748/wjg.v23.i31.5809.
    [21]
    CERUTTI E, STRATTA C, ROMAGNOLI R, et al. Bacterial- and fungal-positive cultures in organ donors: clinical impact in liver transplantation[J]. Liver Transpl, 2006, 12(8): 1253-1259. DOI: 10.1002/lt.20811.
    [22]
    BUNSOW E, LOS-ARCOS I, MARTIN-GÓMEZ MT, et al. Donor-derived bacterial infections in lung transplant recipients in the era of multidrug resistance[J]. J Infect, 2020, 80(2): 190-196. DOI: 10.1016/j.jinf.2019.12.006.
    [23]
    MARTIN-LOECHES I, RODRIGUEZ AH, TORRES A. New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs. Europe[J]. Curr Opin Crit Care, 2018, 24(5): 347-352. DOI: 10.1097/MCC.0000000000000535.
    [24]
    中华医学会器官移植学分会. 器官移植供者来源性感染诊疗技术规范(2019版)[J]. 器官移植, 2019, 10(4): 369-375. DOI: 10.3969/j.issn.1674-7445.2019.04.005.

    Branch of Organ Transplantation of Chinese Medical Association. Technical specification for diagnosis and treatment of donor-derived infection in organ transplantation (2019 edition)[J]. Organ Transplant, 2019, 10(4): 369-375. DOI: 10.3969/j.issn.1674-7445.2019.04.005.
    [25]
    BENAMU E, WOLFE CR, MONTOYA JG. Donor-derived infections in solid organ transplant patients: toward a holistic approach[J]. Curr Opin Infect Dis, 2017, 30(4): 329-339. DOI: 10.1097/QCO.0000000000000377.
    [26]
    WAN Q, LIU H, YE S, et al. Confirmed transmission of bacterial or fungal infection to kidney transplant recipients from donated after cardiac death (DCD) donors in China: a single-center analysis[J]. Med Sci Monit, 2017, 23: 3770-3779. DOI: 10.12659/msm.901884.
    [27]
    SATLIN MJ, WALSH TJ. Multidrug-resistant enterobacteriaceae, pseudomonas aeruginosa, and vancomycin-resistant enterococcus: three major threats to hematopoietic stem cell transplant recipients[J]. Transpl Infect Dis, 2017, 19(6): 10.1111/tid. 12762. DOI: 10.1111/tid.12762.
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