OP2 - Evaluating the contamination of organ preservation fluid by microorganisms in solid organ transplantation and its clinical relevance and its clinical relevance

Fernando KDL, Kothalawala M , National Hospital of Sri Lanka

Abstract

Introduction

Organ preservation fluid (OPF) maintains graft viability during transfer from donor to recipient in solid organ transplantation (SOT). OPF may be contaminated by endogenous microorganisms from the donated organ or exogenous microorganisms during the perioperative period.

 Objectives

To assess the prevalence of OPF contamination, types of microorganisms and clinical relevance in SOT.

 Design, setting, and methods

A descriptive study was conducted at the National Hospital and NINDT, from November 2022 to March 2023. Sixty SOT events were studied, including both live and deceased donors (58 renal, 2 liver). OPF was collected from the container in which the organ was stored, just after the organ had been removed to be placed in the recipient. Ten millilitres of OPF was directly enriched in an automated blood culture (BC) bottle (B1). Another 20mL was centrifuged at 2500 rpm for 5 minutes; Part of the sediment was enriched in an automated BC bottle (B2), and part was directly plated on blood, chocolate, MacConkey and Sabouraud agar.

Results

The prevalence of culture-positive OPF was as follows: on direct plating, 3.3% (2/60); B1: 81.7% (49/60); B2:75% (45/60); B1+B2 (if at least one bottle positive):86.7% (52/60). Among them, 16.7% (10/60) of SOT events had OPF cultures positive with high-risk organisms. One SOT event had 2 high-risk organisms isolated in OPF culture; therefore, a total of 11 high-risk organisms were isolated (Gram-negatives, 91%, 10/11; Staphylococcus aureus, 9%, 1/11).  Incidence of OPF-related infection was 3.84% (2/52). They had OPF culture positive for MDR Acinetobacter baumannii and infections with the same organism. In both instances, the deceased donors’ blood cultures had been positive for the same organism (donor-derived infections). Recipients with positive OPF cultures were more likely to experience adverse outcomes compared to those with negative OPF cultures, eg, acute graft rejection 9.6% (n=5) vs 0% and mortality 3.8% (n=2) vs 0%.

 Conclusions

Although OPF-related infections were rare, OPF contamination was common in this study. Strengthening the infection control measures may be beneficial. Poorer transplant outcomes may be linked to positive OPF cultures.