Incidence and clinical relevance of bacterial contamination in preservation solution for liver transplantation.
OBJECTIVE
Postoperative infection is considered one of the most important causes of morbidity and mortality after liver transplantation. We prospectively studied the incidence and significance of infections in preservation solutions for liver transplantation.


METHODS
From March 2007 to March 2008, we cultured the University of Wisconsin preservation solution for 60 consecutive liver transplantations. Fluid samples were obtained at the beginning and at the end of the back table procedure. Our posttransplant infection prophylactic protocol consisted of ampicillin and cefotaxime for 48 hours.


RESULTS
Cultures were positive in 59 patients (98.4%). Seventy-five percent of the isolates were superficial saprophytic flora (SSF; Staphylococcus coagulase negative, Streptococcus viridans, and Corynebacterium), nevertheless in 15 cases (25.1%) we isolated high virulence pathogens (Staphylococcus aureus, Klebsiella, Escherichia coli, Enterobacter, and Pseudomonas aeruginosa). There were neither anaerobic nor fungal isolates. Sixteen patients (36%) from the group with SSF developed postoperative fever, including 12 with negative posttransplant cultures, while 4 patients showed positive cultures for various microorganisms distinct from those isolated from the preservation solution. Five patients (30%) with high virulence pathogens in the preservation solution developed posttransplant fever, although no pathogen was isolated.


CONCLUSIONS
Positive cultures of preservation fluids were observed in 98% of patients, although most of them (75%) were SSF. Microorganisms isolated from posttransplant cultures did not match the ones obtained from the preservation solution. Our results did not support routine culturing of the preservation solution provided that one administrator an adequate posttransplant antibiotic prophylactic regimen.
Ruiz
P
P
Transplantation and Liver Surgery Unit, Hospital de Cruces, Barakaldo, Vizcaya, Spain. Patru@euskalnet.net
Gastaca
M
M
Gonzalez
J
J
Hernandez
M J
MJ
Ventoso
A
A
Valdivieso
A
A
Montejo
M
M
Ortiz de Urbina
J
J
D000241:Adenosine; D000493:Allopurinol; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002439:Cefotaxime / Q000627:therapeutic use; D003352:Corynebacterium / Q000187:drug effects; D004926:Escherichia coli / Q000187:drug effects / Q000472:pathogenicity; D005978:Glutathione; D006801:Humans; D007328:Insulin; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D019188:Organ Preservation Solutions / Q000592:standards*; D011446:Prospective Studies; D011887:Raffinose; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology*; D013210:Staphylococcus / Q000187:drug effects; D013211:Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity; D034363:Viridans Streptococci / Q000187:drug effects; D014774:Virulence
D000900:Anti-Bacterial Agents; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D000667:Ampicillin; D005978:Glutathione; D000241:Adenosine; D002439:Cefotaxime; D011887:Raffinose