Early and long-term outcomes of primary infected kidney transplantation

Introduction. The transplantation of primary infected grafts poses a significant challenge in the field of kidney transplantation. This issue is not adequately addressed in the existing medical literature. In our country, no systematic studies of the results of such transplants have been conducted.

Objective. To evaluate the frequency of primary infected kidney transplants and the types of microorganisms isolated from positive bacterial cultures of perfusates; to study the frequency of clinically significant infectious complications in this category of patients and their outcomes; to identify factors that had a statistically significant impact on the outcomes.

Material and methods. Between 1 January 2015 and 31 December 2024, 1,923 kidney transplants from deceased donors were performed. The study group consisted of 87 patients who tested positive for bacterial perfusion culture. Of these, 42 (48.3%) were men and 45 (51.7%) were women. The average age of the patients was 47±11.9 years. Patients were divided into two groups to assess the impact of clinically significant infectious complications on treatment outcomes: group I consisted of 15 patients with such complications and group II consisted of 72 patients without. Patients in both groups were comparable in terms of key characteristics.

Results. The frequency of initially infected kidney transplants was 4.5%. The microorganisms causing perfusion contamination were as follows: 88 bacterial strains and one fungal strain. Of these bacteria, 51 were Gram-positive, 36 were Gram-negative and one was anaerobic. Clinically significant infectious complications occurred in 17.2% of cases, with a median time to development of 9 (4;12) days. The development of infectious complications significantly reduced kidney transplant survival. Significant factors included clinically significant infectious complications, the detection of Klebsiella pneumoniae in the perfusate and type 2 diabetes mellitus in patients.

Conclusion. The frequency of primary infected kidney transplants, as well as the frequency of clinically significant infectious complications, is consistent with data from other transplant centers. Algorithms for diagnosing and treating infectious complications enabled fatal outcomes to be avoided in this patient group.

1. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease – a systematic review and metaanalysis. PLoS One. 2016;11(7):e0158765. PMID: 27383068 https://doi.org/10.1371/journal.pone.01587657

2. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global burden of disease study 2017. Lancet. 2020;395(10225):709–733. PMID: 32061315 https://doi.org/10.1016/S0140-6736(20)30045-3

3. Jha V, Al-Ghamdi SMG, Li G, Wu MS, Stafylas P, Retat L, et al. Global economic burden associated with chronic kidney disease: a pragmatic review of medical costs for the Inside CKD research programme. Adv Ther. 2023;40(10):4405– 4420. PMID: 37493856 https://doi.org/10.1007/s12325-023-02608-9

4. Yang CW, Harris DCH, Luyckx VA, Nangaku M, Hou FF, Garcia Garcia G, et al. Global case studies for chronic kidney disease/end-stage kidney disease care. Kidney Int Suppl (2011). 2020;10(1):e24e48. PMID: 32149007 https://doi.org/10.1016/j.kisu.2019.11.010

5. Matesanz R, Mahi ́ llo B. The current situation regarding organ donation and transplantation in Europe. In: Figueiredo A, Lledo ́ -Garci ́ a E. (eds.) European Textbook on Kidney Transplantation. Arnhem, Netherlands; 2017. p. 59-86.

6. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2023. 16th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2024;26(3):8–31. (In Russ.). https://doi.org/10.15825/1995-1191-2024-3-8-31

7. Poggio ED, Augustine JJ, Arrigain S, Brennan DC, Schold JD. Long-term kidney transplant graft survival-making progress when most needed. Am J Transplant. 2021;21(8):2824–2832. PMID: 33346917 https://doi.org/10.1111/ajt.16463

8. Lentine KL, Smith JM, Miller JM, Bradbrook K, Larkin L, Weiss S, et al. OPTN/SRTR 2021 Annual Data Report: kidney. Am J Transplant. 2023;23(2 Suppl 1):S21-S120. PMID: 37132350 https://doi.org/10.1016/j.ajt.2023.02.004

9. Morgan G, Goolam-Mahomed Z, Hodson J, Nath J, Sharif A. Recipient sex differences in kidney graft survival are influenced by donor sex and recipient age. Exp Clin Transplant. 2021;19(3):190–203. PMID: 33605196 https://doi.org/10.6002/ect.2020.0112

10. Nasic S, Peters B, Stegmayr B, Kenne Sarenmalm E, Afghahi H, Eriksson M. Sex-specific time trends of longterm graft survival after kidney transplantation – a registry-based study. Ren Fail. 2023;45(2):2270078. PMID: 37882045 https://doi.org/10.1080/0886022X.2023.2270078

11. Cancino-López JD, Hernández-Aguilar U, Oribe-Aguilar DI, Rojas-Montiel D, Escobar-Nieto JÁ, Pineda-Morales M, et al. [Transplant patient and kidney graft survival in a retrospective cohort in Mexico]. Rev Med Inst Mex Seguro Soc. 2022;60(1):52–58. PMID: 35271225 (In Spanish).

12. Lewis JD, Sifri CD. Multidrug-resistant bacterial donor-derived infections in solid organ transplantation. Curr Infect Dis Rep. 2016;18(6):18. PMID: 27115701 https://doi.org/10.1007/s11908-0160526-9

13. Fishman JA. From the classic concepts to modern practice. Clin Microbiol Infect. 2014;20(Suppl 7):4–9. PMID: 24528498 https://doi.org/10.1111/1469-0691.12593

14. Fishman JA. Infection in organ transplantation. Am J Transplant. 2017;17(4):856–879. PMID: 28117944 https://doi.org/10.1111/ajt.14208

15. Benamu E, Wolfe CR, Montoya JG. Donor-derived infections in solid organ transplant patients: toward a holistic approach. Curr Opin Infect Dis. 2017;30(4):329–339. PMID: 28538045 https://doi.org/10.1097/QCO.0000000000000377

16. Mularoni A, Cona A, Campanella M, Barbera F, Medaglia AA, Cervo A, et al. Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety. Am J Transplant. 2024;24(6):1046– 1056. PMID: 38342183 https://doi.org/10.1016/j.ajt.2024.02.005

17. Kaul DR. Donor-derived infection: epidemiology and outcomes. Curr Infect Dis Rep. 2012;14(6):676–682. PMID: 23073622 https://doi.org/10.1007s11908-012-0300-6

18. Cerutti E, Stratta C, Romagnoli R, Serra R, Lepore M, Fop F, et al. Bacterial- and fungal-positive cultures in organ donors: clinical impact in liver transplantation. Liver Transpl. 2006;12(8):1253–1259. PMID: 16724336 https://doi.org/10.1002/lt.20811

19. Singh N, Huprikar S, Burdette SD, Morris MI, Blair JE, Wheat LJ; American Society of Transplantation, Infectious Diseases Community of Practice, Donor-Derived Fungal Infection Working Group. Donor-derived fungal infections in organ transplant recipients: guidelines of the American Society of Transplantation, infectious diseases community of practice. Am J Transplant. 2012;12(9):2414–2428. PMID: 22694672 https://doi.org/10.1111/j.16006143.2012.04100.x

20. Malinis M, Boucher HW; AST Infectious Diseases Community of Practice. Screening of donor and candidate prior to solid organ transplantation – Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13548. PMID: 30900327 https://doi.org/10.1111/ctr.13548

21. Oriol I, Sabé N, Tebé C, Veroux M, Boin IFSF, Carratalà J. Clinical impact of culture-positive preservation fluid on solid organ transplantation: a systematic review and meta-analysis. Transplant Rev (Orlando). 2018;32(2):85–91. PMID: 29275111 https://doi.org/10.1016/j.trre.2017.11.003

22. Corbel A, Ladrière M, Le Berre N, Durin L, Rousseau H, Frimat L, et al. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study. Clin Microbiol Infect. 2020;26(4):475–484. PMID: 31382016 https://doi.org/10.1016/j.cmi.2019.07.018

23. Al Midani A, Hookham L, Banga N, Jones G, Collier S. The Value of perfusion fluid culture analysis in deceased donor renal transplants: a 10-year single-center experience. Transplant Proc. 2021;53(6):1808–1812. PMID: 33962779 https://doi.org/10.1016/j.transproceed.2021.03.023

24. Li J, Su X, Li J, Wu W, Wu C, Guo P, et al. The association of organ preservation fluid pathogens with early infectionrelated events after kidney transplantation. Diagnostics (Basel). 2022;12(9):2248. PMID: 36140649 https://doi.org/10.3390/diagnostics12092248

25. Bertrand D, Pallet N, Sartorius A, Zahar JR, Soussan RS, Lortholary O, et al. Clinical and microbial impact of screening kidney allograft preservative solution for bacterial contamination with high-sensitivity methods. Transpl Int. 2013;26(8):795–799. PMID: 23734610 https://doi.org/10.1111/tri.12130

26. Mattana AM, Marra AR, Machado AM, Lopes Filho Gde J, Salzedas Netto AA, Gonzalez AM. Evaluation of the presence of microorganisms in solid-organ preservation solution. Braz J Infect Dis. 2011;15(6):528–532. PMID: 22218510 https://doi.org/10.1590/s1413-86702011000600005

27. Yu X, Wang R, Peng W, Huang H, Liu G, Yang Q, et al. Incidence, distribution and clinical relevance of microbial contamination of preservation solution in deceased kidney transplant recipients: a retrospective cohort study from China. Clin Microbiol Infect. 2019;25(5):595– 600. PMID: 30659919 https://doi.rg/10.1016/j.cmi.2018.12.040

28. Isenberg HD. (eds.) Clinical Microbiology. Procedures Handbook. Washington, D.C.: American Society of Microbiology; 1992.

29. Hamed MO, Chen Y, Pasea L, Watson CJ, Torpey N, Bradley JA, et al. Early graft loss after kidney transplantation: risk factors and consequences. Am J Transplant. 2015;15(6):1632–1643. PMID: 25707303 https://doi.org/10.1111/ajt.13162

30. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. PMID: 24141714 https://doi.org/10.1001/jama.2013.281053

31. Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019;34(11):1803– 1805. PMID: 31566230 https://doi.org/10.1093/ndt/gfz174

32. Hernández D, Muriel A, Abraira V. Current state of clinical end-points assessment in transplant: key points. Transplant Rev (Orlando). 2016;30(2):92– 99. PMID: 26948088 https://doi.org/10.1016/j.trre.2016.02.003

33. Lentine KL, Smith JM, Lyden GR, Miller JM, Dolan TG, Bradbrook K, et al. OPTN/SRTR 2022 Annual Data Report: kidney. Am J Transplant. 2024;24(2S1):S19-S118. PMID: 38431360 https://doi.org/10.1016/j.ajt.2024.01.012

34. Voora S, Adey DB. Management of kidney transplant recipients by general nephrologists: core curriculum 2019. Am J Kidney Dis. 2019;73(6):866–879. PMID: 30981567 https://doi.org/10.1053/j.ajkd.2019.01.031

35. Kauffman CA, Freifeld AG, Andes DR, Baddley JW, Herwaldt L, Walker RC, et al. Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET). Transpl Infect Dis. 2014;16(2):213–224. PMID: 24589027 https://doi.org/10.1111/tid.12186

36. Neofytos D, Fishman JA, Horn D, Anaissie E, Chang CH, Olyaei A, et al. Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients. Transpl Infect Dis. 2010;12(3):220–229. PMID: 20113459 https://doi.org/10.1111/j.1399-3062.2010.00492.x

37. Suzuki Y, Kenjo A, Togano T, Yamamoto N, Ohto H, Kume H. Infectious diseases in solid organ transplant recipients: analysis of autopsied cases in Japan. J Infect Chemother. 2017;23(8):531– 537. PMID: 28647177 https://doi.org/10.1016/j.jiac.2017.05.001

38. Kauffman CA, Miceli MH. Histoplasmosis and blastomycosis in solid organ transplant recipients. J Fungi (Basel). 2015;1(2):94–106. PMID: 29376901 https://doi.org/10.3390/jof1020094

39. Hemmersbach-Miller M, Alexander BD, Sudan DL, Pieper C, Schmader KE. Single-center analysis of infectious complications in older adults during the first year after kidney transplantation. Eur J Clin Microbiol Infect Dis. 2019;38(1):141–148. PMID: 30353487 https://doi.org/10.1007/s10096-018-3405-5

40. Piskorska K, Sikora M, Go ł a ś M, D ą bkowska M, P ą czek L, SwobodaKope ć E. Invasive candidiasis serological diagnosis in solid organ transplant recipients. Cent Eur J Immunol. 2014;39(2):187–192. PMID: 26155122 https://doi.org/10.5114/ceji.2014.43721

41. Prakash J, Ghosh B, Singh S, Soni A, Rathore SS. Causes of death in renal transplant recipients with functioning allograft. Indian J Nephrol. 2012;22(4):264–268. PMID: 23162269 h t t p s : / / d o i . o r g / 1 0 . 4 1 0 3 / 0 9 7 1 -4065.101245

42. Siritip N, Nongnuch A, Dajsakdipon T, Thongprayoon C, Cheungprasitporn W, Bruminhent J. Epidemiology, risk factors, and outcome of bloodstream infection within the first year after kidney transplantation. Am J Med Sci. 2021;361(3):352–357. PMID: 33309136 https://doi.org/10.1016/j.amjms.2020.10.011

43. Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of renal transplant complications throughout the life of the allograft: comprehensive multimodality review. Radiographics. 2019;39(5):1327–1355. PMID: 31498742 https://doi.org/10.1148/rg.2019190096

44. Skov Dalgaard L, Nørgaard M, Povlsen JV, Morrissey O, Jespersen B, Jensen-Fangel S, Risk and prognosis of bacteremia and fungemia among firsttime kidney transplant recipients: a population-based cohort study. Infect Dis (Lond). 2017;49(4):286–295. PMID: 27822975 https://doi.org/10.1080/23744235.2016.1248483

45. Kinnunen S, Karhapää P, Juutilainen A, Finne P, Helanterä I. Secular trends in infection-related mortality after kidney transplantation. Clin J Am Soc Nephrol. 2018;13(5):755–762. PMID: 29622669 https://doi.org/10.2215/CJN.11511017

46. Andes DR, Safdar N, Baddley JW, Alexander B, Brumble L, Freifeld A, et al.; TRANSNET Investigators. The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Transpl Infect Dis. 2016;18(6):921–931. PMID: 27643395 https://doi.org/10.1111/tid.12613

47. Fischer SA. Is this organ donor safe? Donor-derived infections in solid organ transplantation. Infect Dis Clin North Am. 2018;32(3):495–506. PMID: 30146019 https://doi.org/10.1016/j.idc.2018.04.001

48. Gr ą t M, Ligocka J, Lewandowski Z, Barski K, Ho ł ó wko W, Skalski M, et al. Incidence, pattern and clinical relevance of microbial contamination of preservation fluid in liver transplantation. Ann Transplant. 2012;17(3):20–28. PMID: 23018252 https://doi.org/10.12659/aot.883454

49. Yansouni CP, Dendukuri N, Liu G, Fernandez M, Frenette C, Paraskevas S, et al. Positive cultures of organ preservation fluid predict postoperative infections in solid organ transplantation recipients. Infect Control Hosp Epidemiol. 2012;33(7):672–680. PMID: 22669228 https://doi.org/10.1086/666344

50. Ison MG, Grossi P; AST Infectious Diseases Community of Practice. Donorderived infections in solid organ transplantation. Am J Transplant. 2013;13 (Suppl 4):22–30. PMID: 23464995 https://doi.org/10.1111/ajt.12095

51. Mularoni A, Bertani A, Vizzini G, Gona F, Campanella M, Spada M, et al. Outcome of transplantation using organs from donors infected or colonized with carbapenem-resistant gramnegative bacteria. Am J Transplant. 2015;15(10):2674–2682. PMID: 25981339 https://doi.org/10.1111/ajt.13317

52. Cai YS, Xiao H, Zhang S, Li M, Liang SM, Shi ZR, et al. Carbapenemresistant Klebsiella pneumoniae infection causing rupture of graft artery in solid organ recipients: case report and review of literature. Medicine (Baltimore). 2019;98(45):e17878. PMID: 31702658 https://doi.org/10.1097/MD.0000000000017878

53. Kieslichova E, Protus M, Nemcova D, Uchytilova E. Single multidrug resistant Enterobacteriaceae donor-derived infection in four solid organ transplant recipients: a case report. BMC Surg. 2019;19(1):111. PMID: 31412850 https://doi.org/10.1186/s12893-019-0574-9

54. Reticker A, Lichvar A, Walsh M, Gross AE, Patel S. The significance and impact of screening preservation fluid cultures in renal transplant recipients. Prog Transplant. 2021;31(1):40– 46. PMID: 33297862 https://doi.org/10.1177/1526924820978608

55. Cotter MP, Smyth E, O'Gorman J, Browne S, Hickey DP, Humphreys H. Low predictive value of positive transplant perfusion fluid cultures for diagnosing postoperative infections in kidney and kidney-pancreas transplantation. J Clin Pathol. 2012;65(12):1132– 1135. PMID: 22918888 https://doi.org/10.1136/jclinpath-2012-200918