Value of donor swabs for intra-abdominal infection in simultaneous pancreas-kidney transplantation

Correlation of intraoperative donor duodenal-segment swab cultures with the subsequent occurrence of surgical site infections in kidney and pancreas transplant recipients

BACKGROUND

Pancreas transplantation is employed for the treatment of type I diabetes mellitus. It is postulated that surgical site infection (SSI), particularly organ-space infections, after pancreas transplantation may arise from microbial contamination arising from the donor duodenal segment. Therefore, some centers have adopted the practice of culturing the donor duodenal segment and subsequently administering antimicrobial therapy to the recipient directed at the microorganisms isolated to prevent SSI.

METHODS

In this retrospective cohort study, we evaluated the correlation between positive donor duodenal-segment cultures and SSIs in the recipients. Data were recorded and analyzed to assess the correlation of the organisms isolated in the donor duodenal cultures with those producing SSI in the recipients.

RESULTS

We evaluated 379 consecutive pancreas transplant recipients from January 2000 to December 2015. Donor duodenal swab cultures were performed at the time of pancreas transplantation, and 206 (54.3%) were positive. SSIs occurred in 51 of the 206 recipients (24.8%) with positive duodenal-segment cultures and in 41 of 173 individuals (23.7%) with negative cultures (P = .81; r = 0.00). Notably, deep and organ-space SSIs were observed in 27 of 206 of the positive duodenal culture groups (13.1%) versus 29 of 173 of the negative duodenal culture groups (16.8%; P = 0.31; r = -0.059). No differences were detected in the pathogens producing SSIs between the group with a positive duodenal swab versus the group with a negative swab. Microorganisms producing SSIs matched those found in the positive donor duodenal cultures in only 15 patients (7.8%).

CONCLUSION

Although positive cultures from the donor duodenal segment prompted the administration of antimicrobial therapy in the recipient directed against the pathogen isolated, this practice did not reduce SSIs compared with those transplant recipients with culture-negative duodenal swabs. In addition, the organisms isolated from the donor duodenal segment were not predictive of subsequent SSI.

Risk factors for surgical site infection after kidney and pancreas transplantation

OBJECTIVE

To evaluate the incidence of surgical site infection (SSI) in a cohort of pancreas transplant recipients and assess predisposing risk factors for SSI DESIGN: Retrospective cohort study SETTING: Single transplant center in CanadaPatientsPatients who underwent any simultaneous pancreas and kidney (SPK) or pancreas after kidney (PAK) transplant procedures between January 2000 and December 2015 METHODS: In this retrospective cohort evaluation of SPK or PAK recipients, we assessed the incidence of SSI and risk factors associated with superficial, deep, and organ/space SSI. Multivariate logistic regression was used to identify independent risk factors for SSI in SPK and PAK recipients.

RESULTS

In total, 445 adult transplant recipients were enrolled. The median age of these patients was 51 years (range, 19-71 years), and 64.9% were men. SSIs were documented in 108 patients (24.3%). Organ/space SSIs predominated (59 patients, 54.6%), followed by superficial SSIs (47 patients, 43.5%) and deep SSIs (3 patients, 2.8%). Factors predictive of SSIs in the multivariate analysis were cold pancreas ischemic time (odds ratio [OR], 1.002; P=.019) and SPK transplant (compared to PAK transplant recipients; OR, 2.38; P=.038). Patients with SSIs developed graft loss more frequently (OR, 16.99; P<.001).

CONCLUSIONS

Organ/space SSIs remain a serious and common complication after SPK and PAK. Prolonged cold ischemic time and SPK transplant were the risk factors predictive of SSIs. Appropriate perioperative prophylaxis in high-risk patients targeting the potential pathogens producing SSIs in kidney and/or pancreas transplant recipients and a reduction in cold ischemia may prove beneficial in reducing these SSIs.

Canadian clinical practice guidelines for invasive candidiasis in adults

Candidemia and invasive candidiasis (C/IC) are life-threatening opportunistic infections that add excess morbidity, mortality and cost to the management of patients with a range of potentially curable underlying conditions. The Association of Medical Microbiology and Infectious Disease Canada developed evidence-based guidelines for the approach to the diagnosis and management of these infections in the ever-increasing population of at-risk adult patients in the health care system. Over the past few years, a new and broader understanding of the epidemiology and pathogenesis of C/IC has emerged and has been coupled with the availability of new antifungal agents and defined strategies for targeting groups at risk including, but not limited to, acute leukemia patients, hematopoietic stem cell transplants and solid organ transplants, and critical care unit patients. Accordingly, these guidelines have focused on patients at risk for C/IC, and on approaches of prevention, early therapy for suspected but unproven infection, and targeted therapy for probable and proven infection.

Octreotide attenuates impaired microcirculation in postischemic pancreatitis when administered before induction of ischemia

BACKGROUND

Ischemia-reperfusion injury of the pancreas causes impairment of microcirculation leading to pancreatitis. Postischemic pancreatitis is the most common reason for graft failure in pancreas transplantation. In animal models, octreotide has been described to have beneficial effects on acute pancreatitis by reducing pancreatic enzyme release and edema formation by preventing the increase of macromolecular extravasation. In contrast to earlier experimental setups, this study investigated the influence of octreotide on ischemia-reperfusion pancreatitis when administered before induction of ischemia.

METHODS

Sprague-Dawley rats were randomly assigned to three groups: (1) sham-operated animals (sham group, n=7); (2) 1 hr ischemia followed by 1 hr reperfusion (control group, n=7); (3) administration of 50 microg/kg octreotide intravenously 15 min before ischemia (octreotide group, n=7). At the end of reperfusion, intravital fluorescence microscopy was performed assessing the functional capillary density (FCD), leukocyte-endothelium interaction (LEI), and the microvascular permeability. Finally serum amylase and lipase were measured.

RESULTS

The application of octreotide significantly reduced the ischemia-reperfusion-induced reduction of FCD (318.4+/-44.1 cm/cm vs. 257.4+/-11.7 cm/cm, P<0.001). The increase of LEI due to ischemia-reperfusion (466.9+/-52.2 cells/mm) was reduced in the octreotide group (264.4+/-55.1, P=0.001). Permeability was significantly lower in the octreotide group (0.56+/-0.57x10 cm/sec vs. 2.2.1+/-0.54x10 cm/sec, P<0.001). The level of serum lipase was reduced significantly after octreotide therapy (72.4+/-53.4 U/L vs. 136.7+/-66.5 U/L, P=0.026).

CONCLUSION

Octreotide significantly attenuated pancreatic dysfunction caused by ischemia-reperfusion when given before ischemia. Furthermore, we could prove for the first time a beneficial role of octreotide on preservation of the microvascular barrier for macromolecules.

Outcome and morbidity of pancreas transplantation in a single Spanish institution

BACKGROUND

Pancreas transplantation is nowadays the only treatment to reestablish normal blood glucose in diabetic patients. Moreover, transplantation may also prevent and possibly even revert diabetes-related complications. We present our results with the first 4 years of a pancreas transplantation program.

MATERIALS AND METHODS

From February 2000 to June 2004, we performed 43 pancreas transplants in 42 recipients. In all cases the technique was enteric drainage of the exocrine secretions and systemic venous derivation to the inferior vena cava for endocrine secretions.

RESULTS

A simultaneous pancreas-kidney transplant was performed in 37 (88.1%) patients, a pancreas after kidney in 4 (9.5%) patients, and a retransplant in 1 (2.4%) patient. Glycosylated hemoglobin and C peptide returned to normal values in all cases. Patient and graft survivals were 91% and 84%, respectively, after a median follow-up of 19 months. The rate of reoperations was 31% with an overall 16% graft loss.

CONCLUSIONS

Our results were comparable to those of larger series.

Trasplante de páncreas: resultados del grupo Málaga

INTRODUCTION

Pancreatic transplantation is currently the only therapeutic alternative able to restore normal blood glucose levels in diabetic patients. Moreover, this procedure can halt or even reverse diabetes-related complications. The aim of this study was to present our experience and the results of the first 4 years of a pancreatic transplantation program in our center.

MATERIAL AND METHOD

From February 2000 to June 2004, 43 pancreatic transplantations were performed in 42 recipients in the Carlos Haya Regional Hospital in Malaga (Spain). In all patients, the technique of enteric drainage of exocrine pancreatic secretions and systemic venous shunting of endocrine secretions (to the inferior vena cava) was used.

RESULTS

There were 37 (88.1%) simultaneous pancreas-kidney transplantations, 4 (9.5%) in patients with prior kidney transplantation and 1 retransplantation (2.4%). In all patients, glycosylated hemoglobin and C-peptide levels returned to normal. Patient and pancreatic graft survival were 91% and 84%, respectively, with a median follow-up of 19 months. The reintervation rate was 31%, with an overall rate of graft loss of 16%.

CONCLUSIONS

The results obtained in our series are similar to those reported for large series.

Therapie von Mykosen im Rahmen einer kombinierten Pankreas-Nieren-Transplantation. Therapy of mycoses after simultaneous pancreas-kidney transplantation

Patients suffering from type I diabetes mellitus have a descending expectancy of life, after developing diabetic nephropathy and undergoing haemodialysis. After 3 years of haemodialysis, approximately only 40% of the patients are still alive. The only remedy of this incurable metabolic disease is the simultaneous pancreas-kidney transplantation. After transplantation, fungal colonization and fungal infection is a serious threat for the patient's life. In this context, it is necessary to distinguish between colonization and invasive mycosis. In the case of unsuccessful antimycotic treatment, the removal of the transplanted organ, depending on the patient's condition, may be necessary to save the patient's life.