Costa Silva Alberto, Pina-Vaz Teresa, Pinho Ana, Ferreira Inês, Cerqueira Ana, Bustorff Manuela, Sampaio Susana, Roncon-Albuquerque Roberto, Rios Margarida, Pestana Manuel, Martins-Silva Carlos, Antunes-Lopes Tiago, Alturas Silva João
Urology Department, University Hospital Center of São João, Porto, Portugal.
Faculty of Medicine, University of Porto, Porto, Portugal.
Transpl Int. 2025 Jul 25;38:14855. doi: 10.3389/ti.2025.14855. eCollection 2025.
Infectious complications remain a significant concern in organ transplantation, and preservation fluid (PF) has been identified as a potential source of microbial contamination. However, the clinical relevance of positive PF cultures, especially in kidney transplants from uncontrolled donation after circulatory death (uDCD), is not clearly established. This study aims to evaluate and compare the incidence and clinical implications of positive PF cultures in kidney transplants from uDCD and donation after brain death (DBD) donors. A prospective, single-center study was conducted, involving 497 kidney transplants-147 from uDCD and 350 from DBD donors. PF samples were systematically collected at the time of transplantation, cultured, and analyzed. The type of bacteria identified guided antibiotic treatment decisions. Recipients were monitored for the development of bacteremia within the first post-transplant week. Positive PF cultures were significantly more frequent in uDCD transplants (32.0%) compared to DBD (13.7%) (p < 0.001). Coagulase-negative staphylococci predominated in both groups. Despite this, bacteremia rates were comparable-8.5% in uDCD and 6.3% in DBD (p = 0.673)-with no culture-concordant cases. Antibiotics were administered to 10.6% of uDCD and 22.9% of DBD recipients (p = 0.110). Although uDCD kidneys had higher PF contamination, the clinical impact was minimal.
感染性并发症仍是器官移植中的一个重大问题，而保存液（PF）已被确定为微生物污染的一个潜在来源。然而，PF培养阳性的临床相关性，尤其是在循环死亡后非受控捐献（uDCD）的肾移植中，尚未明确确立。本研究旨在评估和比较uDCD供肾和脑死亡（DBD）供肾肾移植中PF培养阳性的发生率及临床意义。进行了一项前瞻性单中心研究，纳入497例肾移植——147例来自uDCD供肾，350例来自DBD供肾。在移植时系统收集PF样本，进行培养和分析。根据鉴定出的细菌类型指导抗生素治疗决策。对受者在移植后第一周内是否发生菌血症进行监测。与DBD供肾肾移植（13.7%）相比，uDCD供肾肾移植中PF培养阳性更为常见（32.0%）（p<0.001）。两组中凝固酶阴性葡萄球菌均占主导。尽管如此，菌血症发生率相当——uDCD供肾肾移植中为8.5%，DBD供肾肾移植中为6.3%（p = 0.673），且无培养结果一致的病例。10.6%的uDCD受者和22.9%的DBD受者接受了抗生素治疗（p = 0.110）。虽然uDCD供肾的PF污染较高，但临床影响最小。
