Value of donor swabs for intra-abdominal infection in simultaneous pancreas-kidney transplantation.
BACKGROUND
Simultaneous pancreas-kidney transplantation (SPK) has a higher rate of surgical complications compared with other whole organ transplantations. Graft thrombosis and intra-abdominal infections are the most frequent causes for relaparotomy. We evaluated risk factors for abdominal infections after SPK, with emphasis on the value of the routinely taken intraoperative swabs.


METHODS
Between June 1994 and December 2000, 177 SPK were performed. Immunosuppression consisted of antithymocyte globulin induction and triple-drug maintenance therapy. Routine swabs were taken from the graft perfusion solutions, from the donors' duodenum, and from the recipients' bladder and jejunum (in case of enteric drainage).


RESULTS
A total of 19 (10.7%) of 177 patients underwent 41 relaparotomies as a result of intra-abdominal infections. Positive microbial results from any donor site and positive duodenal swabs were significant risk factors for intra-abdominal infections after SPK (P=0.01, P=0.02). There was a significantly higher incidence of abdominal infections when Candida was found in the donor duodenal swab (P=0.0048). Patient survival was significantly lower in cases with abdominal infection (P=0.02). Survival rates of patients with and without abdominal infection were 89.5% and 97.4% at 1 year and 72.3% and 92.8% at 5 years, respectively.


CONCLUSIONS
The results of this study confirm that abdominal infections significantly reduce patient survival and thus jeopardize the success of SPK. Positive donor duodenal swabs have been revealed to be a significant risk factor for a subsequent intra-abdominal infection, especially when Candida was found.
Woeste
Guido
G
Department of Surgery, Ruhr-University Bochum, Knappschaftskrankenhaus Bochum, Germany.
Wullstein
Christoph
C
Vogt
Jörg
J
Zapletal
Christina
C
Bechstein
Wolf Otto
WO
D000005:Abdomen / Q000382:microbiology*; D000328:Adult; D002177:Candidiasis / Q000175:diagnosis / Q000209:etiology; D003949:Diagnostic Techniques, Surgical; D006801:Humans; D015994:Incidence; D007239:Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007432:Intraoperative Period; D016030:Kidney Transplantation / Q000009:adverse effects*; D007813:Laparotomy; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors