RAPID DETECTION OF SYSTEMIC INFECTION OF THE DONORS AND CONTAMINATION OF THE RENAL GRAFTS USING POLYMERASE CHAIN REACTION TECHNIC

Abstract

26 PURPOSE; Since the hospitalized periods of non-heart beating donors (NHBDs) are usually prolonged, the frequency of donor infection as well as organ contamination should be increased. Thus, diagnosing the allograrft contamination during a short pretransplant period is very important. The purpose of this study is to detect contaminated allografts harvested from NHBDs who might be systemically infected by drug resistant organisms such as methicillin resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa (P.aeruginosa) and Candida species by employing polymerase chain reaction (PCR) technic. STUDY SUBJECTS AND METHODS; The preprocurement blood samples of 55 renal donors as well as the preservation solution (PS) and renal pelvic urine (PU) obtained from 115 grafts were analysed by PCR. In PCR, appropriate primers were used to detect following genes; fem A gene specific to Staphylococcus aureus (S.aureus), mec A gene specific to methicillin resistant Staphylococcus species, P.aeruginosa gyr A gene specific to P. aeruginosa and 18S-rDNA gene specific to most of the clinically critical fungi (Candida, Aspergillus, etc.). It takes 4 to 6 hours to make a diagnosis by PCR. In parallel with PCR, rapid shaking culture (RSC) was done and the result of RSC was judged at intervals of 6 hours. RESULTS; Following PCR and RSC, 3 donors were diagnosed to have systemic MRSA infection and the procurement was cancelled, and 4 kidneys were discarded because of the PS contaminations with S.aureus (1), MRSA (2) and Candida species (1). Eighteen kidneys, in which the PCR diagnoses of PS or PU were positive for MRSA or P.aeruginosa, were finally transplanted since the results of RSC at 6 or 12 hours were negative. Only when PCR results of both the PS and PU were negative, the grafts were transplanted into 93 recipients without any delay. Following 111 transplants, no single infectious complication transmitted by the engrafted kidneys was noted. CONCLUSION; PCR combined with RSC is very useful for detecting a systemic infection of the donor and a contamination of the graft in a limited period, especially when a localized infection caused by the drug resistant organisms is found in the cadaveric donor.