INTRODUCTION: Candida cultured in transplant perfusion fluid (TPF) may have adverse consequences (Mai 2006). TPF culture rates, frequency of positive culture results and associated clinical outcomes were audited.

METHOD: Retrospective analysis of prospective data from Jan 2013–June 2014. Culture results of paired organs transplanted elsewhere were obtained via NHSBT

RESULTS: 198/259 (76%) deceased donor transplants had TPF sent for culture.

36/198 (18%) samples were culture positive at 48 hours. Positive bacteria culture rates were similar in DD KT and SPK. Candida culture was 5 times more frequent in SPK compared to DD KT. All Candida culture positive patients received additional anti-fungal therapy and had no direct adverse outcomes. Regarding 29 bacteria positive TPF; 17/29 (59%) patients received extra antibiotics: 2 patients for concurrent chest infection that covered TPF results; 3 patients at re-exploration early post-transplant for unrelated reasons; and 12 patients based only on TPF result and sensitivity. Of these, 11/12 were successfully treated but one DD KT with E. coli in TPF required nephrectomy on day 12 for infection after multiple cultures of the same organism. 4 DD KT and 1 SPK did not receive extra antibiotic after consultant review. Documentation was less clear in 7 patients but all had good outcome. Regarding paired organs with positive TPF: at our unit 9 single organ pairs had 5 concordant positive TPF results; 4 were discordant. The 16 other “pair” kidneys went to 11 UK units (2 for research): 7 units (receiving 10 kidneys) do not routinely culture TPF; 3 units (receiving 4 kidneys) culture TPF, of which, 3 were culture positive.

CONCLUSION: TPF positive cultures were common, with Candida more frequent in SPK than DD KT. Treatment of positive TPF cultures led to good clinical outcomes. We recommend routine TPF culture until a RCT advises otherwise. Communication of positive TPF culture results between UK units may be advised.

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