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

摘要：

目的 调查分析单中心的胸腹联合脏器获取方式对腹腔脏器保存液污染情况及器官保存液相关的供体来源性感染情况。 方法 回顾性分析青岛大学附属医院 2022 年 1 月至 12 月期间符合标准的98 例器官捐献患者临床资料，根据获取器官方式分组 ：胸 + 腹腔脏器获取组（胸腹组）35 例、腹腔脏器获取组（单腹组）63 例。统计气道吸引痰 / 肺泡灌洗液培养、肝 / 肾受者器官保存液培养阳性率，临床判读器官保存液与气道吸引痰 / 肺泡灌洗液培养一致率，临床判读器官保存液相关供体来源性感染的受体抗菌药物使用、疗效。 结果 捐献共 102 例，符合纳入标准 98 例，供体呼吸道相关培养、肝 / 肾器官保存液培养前 5 位致病菌结果分别为 ：① 肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌 ；② 鲍曼不动杆菌、屎肠球菌、葡萄球菌、酵母菌 ；③ 葡萄球菌、屎肠球菌、酵母菌、鲍曼不动杆菌。供体的人口统计学分析仅年龄有显著差异〔胸腹组和单腹组 ：（40.60±11.82）岁比（53.30±13.04）岁〕，供体培养方面，仅胸腹组肝脏器官保存液耐药菌占比（47.4% 比 14.3%，χ2 ＝ 6.191，P ＝ 0.013）存在显著差异，其痰培养阳性率（80% 比 84.1%）、肝 / 肾器官保存液阳性率（54.3% 比 49.1%，75% 比 58.9%）、肾脏器官保存液耐药菌占比（54.2% 比 30.3%）无明显差异。临床判读器官保存液与呼吸道培养一致率（26.5% 比 6.5%）存在显著差异，临床判读一致的供受体配对组合共 13 组，其肝脏和肾脏受体术后早期（＜ 1 个月）供体来源感染率均为 83.3%，通过预防或补救应用抗菌药物治疗后均治愈。 结论 胸腹联合脏器获取方式尽管不会增加器官保存液污染发生率，但增加了呼吸道病原体污染腹腔脏器几率，受体早期抗感染方案需根据器官保存液的结果同时，仍需关注心和/或肺获取供体的呼吸道培养结果，及时预防性/补救性使用抗菌药物。

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