Clinical Analysis Of Donor-derived Infection After Kidney Transplantation Donated By Death Of Citizen

Background: Kidney transplantation is the most effective method for the treatment of end-stage renal disease.At present,the number of donor organs is far less than the needs of recipients,and the shortage of transplant organs is becoming increasingly serious.In order to solve this problem,China encourages citizens to donate organs after death.At present,donation after citizen death（DCD）has become the main source of kidneys.However,such donors often experience major trauma,infection and cardiopulmonary resuscitation before donation,resulting in a significant increase in the incidence of donor-derived infection（DDI）.DDI refers to that after organ donation,the pathogenic microorganisms present in the donor make the recipient obtain the same pathogenic microorganism infection through the organ transplantation process.However,a perfect DDI monitoring system has not been established in China,and most organ transplantation centers do not routinely collect the donor infection information.In order to timely detect the transmission of pathogens,some organ transplantation centers use the kidney lavage fluid as the last link of donor infection screening.The positive rate of lavage fluid culture reported by different transplantation centers varies greatly.Lavage fluid contamination is considered to be a potential way of DDI and may lead to DDI.The recipient infection caused by lavage fluid contamination is a probable donor-derived infection（p-DDI）.At home and abroad,it is not clear about the influence of positive organ lavage fluid culture and p-DDI on transplant recipients.We need to identify the types of microorganisms in lavage fluid to understand the effects of different microorganisms and P-DDI on kidney transplant recipients,so as to intervene early and prevent the occurrence of infection complications.Objective:To investigate the clinical effect of DCD donor kidney transplantation with positive lavage fluid culture and the effect of p-DDI on DCD donor kidney transplantation.Methods:Clinical data of 82 donors from donation after citizen’s death and 148 kidney transplant recipients were retrospectively analyzed.According to the culture results of the lavage fluid of donor kidney,all recipients were divided into the lavage fluid culture of donor kidney positive group and lavage fluid culture of donor kidney negative group.The incidence of infection,delayed graft function（DGF）,acute rejection,graft loss and recipient death were compared between the two groups.At the same time,148 recipients were divided into the P-DDI group and the non-P-DDI group,and the incidence of DGF between the two groups,the incidence of graft kidney bleeding and loss,mortality,postoperative ICU stay,postoperative hospital stay and other perioperative conditions were compared.The distribution and composition ratio of positive strains cultured in kidney lavage fluid were analyzed as well as the distribution of postoperative infection sites in recipients with infection,and the treatment and prognosis of patients with P-DDI were summarized.Results:Among 148 recipients,92 obtained positive culture results in the lavage fluid of donor kidney.A total of 131 pathogenic strains were isolated,including 41.2%（54/131）of Gram-positive cocci,48.9%（64/131）of Gram-negative bacilli and 9.9%（13/131）of fungi.Among 148 recipients,52 cases were infected.And 45%（41/92）and 20%（11/56）of the recipients were infected in the positive and negative group,respectively.The incidence of postoperative infection in positive group was higher than that in negative group,statistical significance was noted between two groups（P=0.002）.Surgical site was the most common infection site in 52 infected recipients,followed by the urinary system.Nineteen recipients developed p-DDI with an incidence rate of 12.8% and fatality of 16%.Compared with the non-p-DDI recipients,p-DDI recipients had significantly higher graft loss rate and fatality,and longer postoperative hospital stay（all P<0.05）.The most common pathogen of P-DDI was Carbapenem-resistant Klebsiella pneumoniae（CRKP）,followed by Enterococcus faecium.Eight cases presented with CRKP infection,after treatment with tigecycline and/or polymyxin and carbapenems,3 cases died,and 3 underwent kidney graft resection.In the other 8 recipients with CRKP infection,2 cases were treated with ceftazidime-avibactam（CAZ-AVI）alone,3 treated with CAZ-A VI combined with carbapenems,and 3 initially treated with tigecycline combined with carbapenems followed by CAZ-AVI for salvage treatment.After corresponding treatment,the recipients achieved long-term survival.Conclusions:Recipients with positive culture of lavage fluid are more likely to be infected after transplantation than those with negative culture,and p-DDI has a negative impact on the prognosis of recipients of kidney transplantation.It is necessary to carry out early antibacterial treatment for pathogens that may cause p-DDI,especially for CRKP.