Introduction: Microbiological analysis of kidney perfusion/transport solution is not routinely performed in all UK transplant centres. The aim of this study is to assess the impact of routine analysis on patient management and outcome. Methods: Data were collected retrospectively on all deceased donor transplants performed between 2009-2013.Organisms detected were classified as either pathological, uncertain pathogenicity, or contaminants. Treatment was guided by the microbiology team .Outcomes including type and duration of treatment, morbidity and mortality, length of hospital stay (LOS) and biopsy-proven acute rejection (BPAR) were compared between recipients receiving grafts with culture-positive (PF+) and culture-negative (PF-) perfusate.Results: In total 328 deceased donor transplants were included, of which 273/328 (83.2%) had perfusate samples analyzed. Organisms were cultured in 50/273 (18.3%) of these samples. Twenty-three different organisms were identified in the PF+ specimens, of which 15/23 (67%) were pathological the most common of which were Escherichia coli, Enterobacter cloacae and 3/50 (6%) cases involved candida. LOS in patients with PF+ was 11 days compared with 7 in PF- patients. There was no difference in morbidity, BPAR rates or mortality between the 2 groups. Directly attributable complications of pathogenic PF+ included wound infection (n=2) and urosepsis (n=3).A statistically significant proportion of PF+ samples came from donors after circulatory death (DCD) perfusate 33/50 (66%) compared with brain-dead (DBD) perfusate 17/50 (34%) (p = 0.0004, Chi-squared test). Conclusion: Identification of organisms in perfusate is common (18.3%) and in 2/3 of cases the organisms are potentially pathological. The similarity in outcomes between PF+ and PF- graft recipients may be secondary to the pro-active identification and treatment of pathological organisms. PF+ graft recipients may subsequently experience longer LOS. PF+ was more frequent in DCD grafts compared to DBD grafts possibly as a result of bacterial translocation during warm ischaemia. Further studies are needed to assess the impact of pro-active treatment PF+ on patient outcomes.

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