Avaliação da contaminação do fluido de preservação de órgãos e do enxerto em transplantes renais

• Ano de defesa: 2025
• Autor(a) principal: Soares, Diogo Peres Martins [UNESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: Solução de preservação; Contaminação; Rim; Enxerto; Transplante
• Link de acesso: https://hdl.handle.net/11449/295412

Introduction: Contamination of preservation solution (PS) in solid organ transplants is relatively underexplored in the literature, and its true impact on postoperative morbidity and mortality in transplants is therefore not well understood. In this study, we characterized the incidence of PF contamination in grafts from kidneys obtained from deceased donors at a leading transplant center. Objective: To evaluate and characterize the contamination rate of the PS and kidney graft from deceased donors, originating from different organ procurement centers in the state of São Paulo, and to attempt to establish a correlation with donor characteristics and the postoperative outcomes of the recipients. Patients and Methods: All kidneys consecutively sent to the Kidney Transplant Center at Hospital das Clínicas of Botucatu Medical School - UNESP, between January 2018 and May 2022, originating from various procurement centers, were retrospectively evaluated. The sampling of the material sent for culture was performed under strict surgical asepsis principles, where approximately 40 milliliters of the preservation solution that was in contact with the kidney and a fragment of perirenal fat were sent, in a sterile container, for analysis of bacterial and fungal contamination. The results obtained were cross-referenced with donor and recipient data, as well as the duration of cold storage. Results: Among the 360 organs evaluated, 59.72% (n = 215) came from male donors and 36.67% (n = 132) from female donors, with a median age of 41 years. Trauma was the leading cause of death in 42% of cases, followed by hemorrhagic stroke in 16%. Among the donors, 61% had no associated comorbidities; however, 25% were hypertensive, 11% were smokers, and 7% used some type of illicit drug. Exclusive renal harvesting occurred in 58% of cases (200 patients), with an ICU stay of 4 days. Documentation of at least one infectious site in the donor occurred in 87 patients (25%), with pulmonary infection responsible for 20% of cases. Approximately 81% of the organs offered for transplantation came from ideal donors, with a creatinine level at the time of procurement of 1.1 mg/dL and a cold ischemia time of 21 hours. Among the recipients, the median age at the time of surgery was 52 years, 60% were male, with an average body mass index of 26 kg/m². Before the transplant, 84% of the recipients had hemodialysis as their main renal replacement therapy, followed by peritoneal dialysis in 12%, with a pre-transplant dialysis duration of 35 months. Among the main causes of renal failure, renal failure of undetermined origin was observed in 30% of the cases, followed by diabetes in 24%, systemic arterial hypertension in 11%, and glomerulopathies in 6% of the cases. The overall contamination rate in the sampled material was 28.9%, with no statistically significant difference between the positivity in the PS and tissue fragment samples (17.5% versus 22%, respectively, p=0.134). The most common isolated organism in PS was Staphylococcus epidermidis (25.3% of the samples analyzed). Considering the high-risk germs, Staphylococcus aureus was the most prevalent (8.4%), followed by Escherichia coli, Klebsiella pneumoniae, Psedomonas sp (5.6%), Enterococcus faecalis, and Candida sp, present in 3.5% of the samples analyzed. The comparison of donor characteristics according to culture positivity did not demonstrate a statistically significant relationship, either with constitutional variables (sex, age, cause of death, presence of diabetes, etc.) or with those related to hospital stay (length of ICU stay, type of donation, cold ischemia time, or even the presence of prior donor infection). Likewise, the comparison of the main unfavorable outcomes associated with the recipient population who underwent RT did not demonstrate a statistically significant difference according to the positivity of the PS/tissue culture. Conclusion: Although the positivity of the cultures obtained from the PS samples was significant, it was not possible to establish a direct correlation between contamination and worse outcomes in the transplanted patients. Similarly, it was not possible to correlate the greater positivity of the cultures with the characteristics of the donor or recipient populations studied.