Microbiological culture results and antibiotic sensitivity in renal preservation solution

Author(s): Mehmet Fatih Yüzbaolu, Hatice Güzel, Gülay Oyur Çelik*, Arzu Tuna, Necla Benlier, Sezgin Topuz, Onur Peker and Alper Boz Aim/Background: The aim of this study is to investigate the effects of the solutions used to preserve kidney during transplant surgeries on microbiological culture results and antimicrobial resistance and to evaluate this process from the perspectives of recipients and donors. ... Abstract View Full Article View DOI: 10.17352/acn.000042

the University of Wisconsin (UW) and the Celsior and Kyoto solutions were extensively used. Each solution has a difference structure and content; however, each solution has the same objective: to prevent cell oedema, to delay cell destruction, and then to provide the best organ function. Preservatives like Bactrim have been added to some solutions in order to preserve organ and tissue and to prevent infection. Particularly in simple hypothermic preservation, the extracted organ is washed with cold preservative solution (+40 C) and placed in a sterile nylon bag. This sterile bag can be put into a second bag with crushed ice particles, and the extracted organ can be preserved. The most signifi cant advantage of this method is that it is cheap, simple and easy to carry the extracted organ [1][2][3][4].
For the preservation of organs and tissues, solutions are used through intravenous infusion immediately after the organ is extracted. The organ should be kept in liquid for preservation.
When the number of donors is taken into consideration, it is inevitable that the organ should be extracted in a successful way. In the past, when the recipient or the donor had any source of infection, it used to cause many diffi culties in organ transplant surgeries [1][2][3][4]. The results of some scientifi c studies reveal that, even if there is infection in the recipient or the donor, this is not an obstacle for a successful transplant surgery as long as antibiotic prophylaxis therapy is performed.
In this context, this study aims to investigate the effects of the solutions used to preserve kidney during transplant surgeries on microbiological culture results and antimicrobial resistance and to evaluate this process from the perspectives of recipients and donors [1][2][3][4].

Methods
This study is a retrospective one, and its data were collected from the fi les of the transplant patients between October 2009 and June 2018. In order to identify the bacteria, the results of the bacteria cultivation conducted through standard methods were included. Gram-negative bacteria were also included in the study. The antimicrobial susceptibility of the identifi ed bacteria was analysed by means of the disk diffusion method.
By analysing the microbiological culture results of the donors, whether bacterial reproduction occurred and whether it was transferred to the recipient were investigated. The permission was obtained from the hospital ethical committee. it was observed that bacterial reproduction occurred in ten donors. In addition, the kidney to be extracted from the donor was washed through renal preservation solutions and kept in liquid. In the cultures taken from the liquids, no bacterial reproduction occurred. When the fi les of the recipients were analysed, it is clearly observed that any reproduction did not occur in any of the cultures taken after after the surgery, although nine of the donors had the microorganisms that could have caused infection. The fact that infection was not observed in the culture results of the recipients is a signifi cant fi nding. This might be connected with the fact that the recipients were supported with a good prophylactic therapy method. Cephalosporin therapy is routinely performed for seven days in clinics after transplant surgeries.

Discussion
The most commonly used renal preservation solutions for kidney transplant surgeries are the Euro-Collins, the University of Wisconsin (UW) and the Bretschneider HTK solutions. In terms of long cold ischemia times, whether the HTC solution or the UW solution is superior has not been demonstrated. As the organ extracted from the living donor should be transplanted immediately, some surgeons prefer to perfuse the kidney with heparinised ringer lactate rather than perfusion fl uids. In order to prolong the period and to prevent infection, antibiotic prophylaxis is very signifi cant [5,6]. While determining the risk of infection after transplant surgeries, although latent and active infections in the donor or the recipient, operationrelated complications, coexistent diseases like Chronic Obstructive Pulmonary Disease (COPD) and the intensity of immunosuppressive therapy are important, there is a timeline for infections that might occur after transplant surgeries. One month after transplant surgeries, transmitter-induces infections, surgical wound and abdominal infections, central catheter infections and hospital acquired pathogens are quite common. Urinary tract infection is also common in this period. the infection related to our study is urinary tract infection [5][6][7]. Opportunistic infections between month 1 and month 6 after transplant surgeries should be considered fi rst. Immunosuppressive maintenance therapy is applied intensively during this period, and the effects of induction therapy are still observable. Therefore, the risk of the reactivation of latent pathogens is very high. Cytomegalovirus (CMV), Herpes zoster virus (HSV), Varicella zoster virus (VZV) and BK virus, Pneumocystis pneumonia (PCP), Aspergillus and Nocardia infections are common Herpes virus. As seen in the study, 1 patient had Herpes virus [5][6][7][8][9]. Oral nystatin or mouthwash is used 3 times a day for oral and oesophageal candidiasis prophylaxis. Although it is recommended for 1-3 months in handbooks, many centres in Turkey use it in the fi rst 3-6 months. It is recommended to use it for at least 1 month after antirejection treatments. In cases where fungal infections are common, oral fl uconazole 1x100 mg can be given instead of oral nystatin for 3-6 months. According to the results of the study, candida infection was observed only in 1 patient [9][10][11][12][13].
Bacteria, which are thought to be caused by the donor and which are already found in the donor, did not cause any endemia in the recipient due to antibiotic treatment in our clinic routine although fungal infection was observed in our study. Despite the measures to prevent possible donor-induced infection in solid organ transplantations, a 0.2-6% infection transition was reported. In addition, at least 5% of the donors were considered to be bacteriemic during the organ uptake [7][8][9]. For that reason, in cadaveric donor transplants, it is recommended that donor cultures should routinely be taken in potential donor candidates with a hospital stay longer than three days. In order to reduce risk, it is recommended that the medical and social history of the donor should be taken into account and that a careful physical examination and laboratory screening should be performed. It should be kept in mind that donor blood cultures can reveal secret bacteriemias and that intensive treatment with hemodynamic insta-bil donors might adversely affect laboratory test results due to hemodilution [9][10][11][12][13].
It is suggested that bacteriemic donors can be used under certain conditions as seen in recent publications.
It is recommended that the infected donor should receive antimicrobial therapy for at least 24-48 hours, that laboratory and clinical response should be considered and that the same antimicrobial therapy should be used for the recipient for 7-14 days. In addition, by means of nonspecifi c antibacterial and antifungal therapy which would be performed independently of the culture results of kidney transplant surgeries from the infected donors, there are centers reporting highly successful results in graft and patient survival in the fi rst six months [9][10][11][12][13].
In our country, the frequency of donor-induced infection in cadaveric donor transplantation is unknown. However, the number of patients for transplant is increasing day by day, and the transplantation of cadaveric donors seems to be the most important source to meet this requirement. With the use of necessary microbiological follow-up and treatment facilities, organs from infected donors can also be provided; however, in this case it is necessary to pay attention especially to organisms that have developed antibiotic resistance. Donor-induced Pseudomonas infections are also important due to their high mortality rate in this group [1,5,6,[9][10][11][12][13].

Result
it should be ensured that reproduction occurring in culture results, whether it is from a living donor or from a cadaver, does not affect organ transplants. If a good treatment is supported by culture antibiogram, it does not create a problem for the recipient and a successful organ transplant surgery can be performed. In this way, there will be no loss of patients in cases where there are not many organ sources.