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Simultaneous kidney, pancreas transplant predicts SSI
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Simultaneous pancreas and kidney transplantation and longer pancreas ischemic times were risk factors for surgical site infections, according to study results recently published in Infection Control & Hospital Epidemiology.
“The evolution of immunosuppressive therapy has reduced rates of acute graft rejection but has enhanced the propensity to develop post-transplant infections,” Yoichiro Natori, MD, of the Multi-Organ Transplant Program, University Health Network, and division of infectious diseases, University of Toronto, and colleagues wrote. “Notably, simultaneous pancreas and kidney transplantation (SPK) has a higher rate of surgical complications than other solid organ transplants. Postoperative, surgical site infections (SSIs) and urinary tract infections are the most prevalent infections after kidney and pancreas transplantations. An SSI often necessitates a repeat laparotomy to drain the intra-abdominal infection.”
Natori and colleagues studied 445 adult patients (median age, 51 years; 64.9% men) who underwent SPK or pancreas after kidney (PAK) transplant procedures between 2000 and 2015 at Toronto General Hospital, University Health Network.
One hundred-eight patients (24.3%) experienced SSIs. Organ/space SSIs were the most common SSI (54.6%); superficial SSIs (43.5%) and deep SSIs (2.8%) also were reported.
Polymicrobial infection Enterococcus species and Candida species, which are not covered by the current prophylactic antimicrobial regimen, were causes of the SSIs. Pancreas ischemic time (OR = 1.002; 95% CI, 1.000-1.004) and SPK transplant compared with PAK transplant recipients (OR = 2.38) were predictive of SSIs when multivariate analysis was conducted.
The researchers reported more frequent graft loss in patients with SSIs (OR = 16.99; P < .001).
Among all patients, those with PAK were less likely to develop an SSI (OR = 0.45; 95% CI, 0.27-0.75) when compared with the patients with SPK.
“Improved surgical technique to reduce cold ischemic time should be undertaken to assess whether this will impact SSI development,” the researchers concluded. “The adequacy of the prophylactic regimen employed in our retrospective study as well as whether 3 days is the optimum duration of prophylaxis may be questioned. The propensity of patients to develop an SSI after pancreas transplant (PT) may potentially be overcome with appropriate antimicrobial prophylaxis addressing the potential pathogens that cause SSI after PT.” – by Bruce Thiel
Disclosures: Natori reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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