title: Perfusion fluid contamination in relation to recipient survival and acute cellular rejection in orthotopic liver transplantation: retrospective analysis.
abstract: BACKGROUND
  A perfusion fluid used in the preservation of a grafted liver represents a medium suitable for microorganism growth. This study investigated the prevalence of perfusion fluid contamination, acute cellular rejection (ACR) episodes, and patient survival rate.
  
  
  METHODS
  This is a retrospective study, based on an electronic database allocating cases of orthotopic liver transplantation. The exclusion criteria were as follows: having been submitted to multiple organ transplantation, liver retransplantation only, and those whose samples had not been collected or sent on the back table procedure or were unobtainable (usually the samples were sent when there was donor infection suspicion/positivity). Our posttransplantation infection prophylactic protocol consisted of ampicillin/sulbactam for 72 hours. The variables in the study were as follows: fluid contamination, presence of acute cellular rejection (ACR, Banff classification), and recipient survival at the first year. Statistical analysis was performed using descriptive statistics and chi-square with Fisher exact test considering significant P<.05.
  
  
  RESULTS
  We observed perfusion fluid contamination in 15/121 (12.39%). The agents were as follows: Klebsiella pneumoniae in 6 (4.96%), Staphylococcus epidermidis in 5 (4.13%), and Acinetobacter baumanii in 3 (2.48%) and negative cultures in 106 (87.60%). Only 1 patient had matching for donor infection and positivity hemoculture after the transplantation (K pneumoniae) and he was the only patient associated with fluid infection and death. The recipients who had their fluid preservation with positive cultures had more ACR and the survival rate was similar among those with or without infection.
  
  
  CONCLUSIONS
  Optimization of microbiological procedures can be performed including fungal and bacterial cultures.
authors.affiliation: Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil.
authors.forename: F H M
authors.initials: FH
authors.lastname: Chaim
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.forename: E C
authors.initials: EC
authors.lastname: Ataide
authors.forename: R S B
authors.initials: RS
authors.lastname: Stucchi
mesh_terms: D000208:Acute Disease; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000276:immunology / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D001938:Brazil; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D004338:Drug Combinations; D006084:Graft Rejection / Q000276:immunology / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008828:Microbiological Techniques; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D010477:Perfusion / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D013407:Sulbactam / Q000008:administration & dosage; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D019188:Organ Preservation Solutions; C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam