Transplantation of microbially contaminated cadaver kidneys
J. A. Majeski, J. W. Alexander, M. R. First, R. Munda, J. P. Fidler and T. K. Craycraft
Bacterial cultures of graft perfusion fluid were taken on 514 renal
perfusions during a ten-year period. A total of 22 positive cultures were
found. Two sets of kidneys were discarded because of the bacteriology
report. Only two possible wound infections were found that could be
attributable to the preoperative contamination even though 19 of 24
patients with "contaminated" kidneys received no antibiotics. No loss of
kidneys or life was found. Of the 22 contaminated perfusates, 18 (80%)
originated from other institutions although only 144 (28%) of the total
kidneys that were perfused came from other institutions. The majority of
cultures indicated that the organisms were skin contaminants or organisms
of low virulence. Microbial contamination of perfused cadaver kidneys is
uncommon (1.2% in local kidneys and 9.3% in shared kidneys). Contaminated
kidneys are not a major source of infection in renal transplant recipients.
Kidneys that are contaminated with frequently virulent Gram-negative
bacteria, such as Escherichia coli, should be discarded. Contamination of
kidneys with Gram-positive organisms should not be a contraindication for
transplantation, but the patients should probably be given prophylactic
antibiotics.