Abstract
The role of contaminated preservation fluid in the development of infection after liver transplantation has not been fully elucidated. To assess the incidence and etiology of contaminated preservation fluid and determine its impact on the subsequent development of infection after liver transplantation, we prospectively studied 50 consecutive liver transplants, and cultured the following samples in each instance: preservation fluid (immediately before and at the end of the back-table procedure, and just before implantation), blood, and bile from the donor, and ascitic fluid from the recipient. When any culture was positive, blood cultures were obtained and targeted antimicrobial therapy was started. We found that the incidence of contaminated preservation fluid was 92% (46 of 50 cases of liver transplantation per year), but only 28% (14/50) were contaminated by recognized pathogens. Blood and bile cultures from the donor were positive in 28% and 6% respectively, whereas ascitic fluid was positive in 22%. The most frequently isolated microorganisms were coagulase-negative staphylococci. In nine cases, the microorganisms isolated from the preservation fluid concurred with those grown from the donor blood cultures, and in one case, the isolate matched with the one obtained from bile culture. No liver transplant recipient developed an infection due to the transmission of an organism isolated from the preservation fluid. Our findings indicate that contamination of the preservation fluid is frequent in liver transplantation, and it is mainly caused by saprophytic skin flora. Transmission of infection is low, particularly among those recipients given targeted antimicrobial treatment for organisms isolated in the preservation fluid.
Highlights
Liver transplantation has become the definitive treatment of several end-stage liver diseases [1,2,3]
We recorded the details of 50 consecutive liver transplantation among 47 patients during the study period
Previous studies have reported a wide variability in the incidence of preservation fluid contamination [7,12,13,14], which may be due to the fact that some reports define contamination as the positive growth of any microorganism, while others require the isolation of known human pathogens [20,21]
Summary
Liver transplantation has become the definitive treatment of several end-stage liver diseases [1,2,3]. With the growing disparity between organ availability and the number of candidates for liver transplantation, most centers have extended the acceptance criteria for PLOS ONE | DOI:10.1371/journal.pone.0160701. Contaminated Preservation Fluid on Liver Transplantation analysis, decision to publish, or preparation of the manuscript With the growing disparity between organ availability and the number of candidates for liver transplantation, most centers have extended the acceptance criteria for PLOS ONE | DOI:10.1371/journal.pone.0160701 August 11, 2016
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