关键词: 胸腹联合脏器获取 , 器官保存液污染 , 供体来源性感染

Abstract:

Objective To investigate the impact of thoraco-abdominal organ procurement on thecontamination of abdominal organ preservation fluid and donor-derived infections related to organ preservation fluid in a single-center study. Methods A retrospective analysis was conducted on the clinical data of 98 organ donors who met the criteria and were admitted to the Affiliated Hospital of Qingdao University from January to December 2022. Those donors were divided into two groups based on organ procurement ：the thoraco-abdominal organ harvest group（35 cases）and the simply abdominal organ harvest group（63 cases）. The positive culture rates of trachealsuction sputum/bronchoalveolar lavage fluid and liver/kidney organ preservation fluid were analyzed. Additionally，the cultural consistency rate between organ preservation fluid and tracheal suction sputum/bronchoalveolar lavage fluid was evaluated by clinical physicians.Antibiotics and therapeutic outcomes in recipients with donor-derived infections related to organ preservation fluid were also assessed. Results A total of 102 organ donations were performed. 98cases met the inclusion criteria. The top five pathogens identified in donor respiratory tract cultures and liver/kidney organ preservation fluid cultures were as follows ：① Klebsiella pneumoniae，Pseudomonas aeruginosa，Acinetobacter baumannii，Staphylococcus aureus ；② Acinetobacter baumannii，Enterococcus faecium，Staphylococcus spp.，Yeast ； ③ Staphylococcus spp.，Enterococcus faecium，Yeast，Acinetobacter baumannii. Demographic analysis showed a significant difference only in age between the thoraco-abdominal and abdominal-only groups（40.60±11.82 vs. 53.30 ± 13.04）. In terms of culture results，a significant difference was observed only in the proportion of drug-resistant bacteria in liver organ preservation fluid in the thoraco-abdominal group（47.4% vs. 14.3%，χ2 ＝6.191，P＝0.013）. There were no significant differences in the positive rates of sputum culture（80% vs. 84.1%），liver and kidney organ preservation fluid（54.3% vs. 49.1%，75% vs. 58.9%），or the proportion of drug-resistant bacteria in kidney organ preservation fluid（54.2% vs. 30.3%）. The consistency rate defined by clinical physicians between organ preservation fluid and respiratory tract culture was significantly higher in the thoraco-abdominal group（26.5% vs. 6.5%）. Among the 13 donor-recipient pairs with consistent culture results，the early postoperative（within 1 month）donor-derived infection rate was 83.3% for both liver and kidney recipients，all of whom were successfully treated with prophylacticor salvage antibiotic therapy. Conclusion Although thoraco-abdominal organ procurement does not increase the contamination rate of organ preservation fluid，it does increase the likelihood of respiratory pathogens contaminating abdominal organs. Early post-transplantation antimicrobial strategies should be based on organ preservation fluid results while also considering respiratory tract culture results from heart and/or lung donors to enable timely prophylactic or salvage antibiotic use. 

Key words:

Thoraco-abdominal organ procurement , Organ preservation fluid contamination , Donorderived infection