The Etiology, Incidence, and Impact of Preservation Fluid Contamination during Liver Transplantation

Abstract

The role of contaminated preservation fluid in the development of infection after liver transplantation has not been fully elucidated. To assess the incidence and etiology of contaminated preservation fluid and determine its impact on the subsequent development of infection after liver transplantation, we prospectively studied 50 consecutive liver transplants, and cultured the following samples in each instance: preservation fluid (immediately before and at the end of the back-table procedure, and just before implantation), blood, and bile from the donor, and ascitic fluid from the recipient. When any culture was positive, blood cultures were obtained and targeted antimicrobial therapy was started. We found that the incidence of contaminated preservation fluid was 92% (46 of 50 cases of liver transplantation per year), but only 28% (14/50) were contaminated by recognized pathogens. Blood and bile cultures from the donor were positive in 28% and 6% respectively, whereas ascitic fluid was positive in 22%. The most frequently isolated microorganisms were coagulase-negative staphylococci. In nine cases, the microorganisms isolated from the preservation fluid concurred with those grown from the donor blood cultures, and in one case, the isolate matched with the one obtained from bile culture. No liver transplant recipient developed an infection due to the transmission of an organism isolated from the preservation fluid. Our findings indicate that contamination of the preservation fluid is frequent in liver transplantation, and it is mainly caused by saprophytic skin flora. Transmission of infection is low, particularly among those recipients given targeted antimicrobial treatment for organisms isolated in the preservation fluid.

Colistin Sulfate for Decontamination of Preservation Fluid to Decrease Donor-derived Infections Caused by Multi-drug Resistant Gram-negative Pathogens

“…The PF contamination rate was 53.36% in our study, and the incidence of p-DDIs was 3.94%, which was consistent with the rates reported in most studies [12]. In most cases, PF contamination seems manageable and harmless and would not lead to severe DDIs [13,14]. However, when reported, the mortality rate of such infections is high [14,15].…”

Candida Contamination in Kidney and Liver Organ Preservation Solution: Does It Matter?

“…Nevertheless, considering the consequences of infection in immunocompromised recipients, the authors concluded that routine culturing of PS should be done. Oriol et al performed a prospective trial culturing donor graft PS, blood, and bile, as well as recipient ascitic fluid [ 25 ]. The incidence of contaminated PS was 92% (46 of 50 cases), but only 28% (14/50) were contaminated by recognized pathogens.…”

The Significance and Impact of Screening Preservation Fluid Cultures in Renal Transplant Recipients

“…The incidence of contamination at our institution was 67%, which was considerably higher than frequently sited rates of 6.4%- 62.5% in the literature. 7–8,14,15,18 -20 The majority of this contamination was with organisms of low virulence. Most frequently, preservation fluid was contaminated with CoNS (56%), which was similar to the incidence of contamination of preservation fluid with CoNS in previous studies (43% to 66.6%).…”

“…Most frequently, preservation fluid was contaminated with CoNS (56%), which was similar to the incidence of contamination of preservation fluid with CoNS in previous studies (43% to 66.6%). 8,18,21– 23 Overall, approximately 80% of microbial growth in preservation fluid was skin flora, implying the majority of this contamination occurred exogenously. Furthermore, none of these organisms in the fluid matched the organisms in the donor cultures.…”