Incidence, pattern and clinical relevance of microbial contamination of preservation fluid in liver transplantation
Michał Grąt, Joanna Ligocka, Zbigniew Lewandowski, Krzysztof Barski, Wacław Hołówko, Michał Skalski, Oskar Kornasiewicz, Paulina Usarek, Krzysztof Zieniewicz, Grażyna Młynarczyk, Marek Krawczyk
Ann Transplant 2012; 17(3): 20-28
Background: Transmission of pathogens via preservation fluid (PF) is a potential cause of infection among liver transplant recipients. Here, we evaluated the incidence and pattern of microbial contamination of PF and its impact on postoperative graft function after liver transplantation.
Material/Methods: This longitudinal study included data from 41 primary liver transplantations and 5 retransplantations performed between December 2010 and September 2011. Results of microbiological analyses of 92 PF samples collected before and after the back-table procedure were evaluated in order to establish the incidence and pattern of contamination. The impact of positive PF cultures on early graft function and rate of pathogen transmission was assessed. Post-transplant antibiotic protocol was based on piperacillin/tazobactam administration for a minimum of 10 days.
Results: The incidence of contamination was 84.8% (39/46), both for samples collected before and after the back-table procedure. Gram-positive low-virulence organisms typical for superficial saprophytic flora, mainly coagulase-negative staphylococci, were predominant. There were no cases of pathogen transmission from PF to the recipient. Positive cultures of PF samples obtained after the back-table procedure were associated with significant elevation of aspartate (p=0.034) and alanine aminotransferase (p=0.048) on the first 5 postoperative days. No significant differences were found regarding serum bilirubin concentration (p=0.335) and international normalized ratio (p=0.137).
Conclusions: Despite high incidence of PF contamination, infections caused by pathogens isolated from PF were not observed. However, presence of pathogens in PF might lead to temporary impairment of graft function.
Keywords: Bacterial Infections, Organ Preservation Solutions, liver transplant recipients