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Kidney outcomes I: infection and rejection

Monday September 12, 2022 - 17:35 to 18:35

Room: CF-1

240.9 Primary-infected renal allograft: variants of the clinical picture and outcomes.

Yuriy A Anisimov, Russian Federation

SRI for Emergency Care n.a. N.V.Sklifosovsky

Abstract

Primary-infected renal allograft: variants of the clinical picture and outcomes

Alexey V Pinchuk1,2,3, Nonna V Shmarina1, Ilia V Dmitriev1, Yuriy Anisimov1, Aslan G Balkarov1, Roman V Storogev1, Denis V Lonshakov1, Alexander S Kondrashkin1, Roman S Kalashnik1, Nikita S Zhuravel1.

1Kidney & Pancreas Transplantation, SRI for Emergency Care n.a.N.V.Sklifosovsky, Moscow, Russian Federation; 2Department of transplantology and artificial organs, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; 3Methodic and organization department for organ transplantation, Scientific-research Institute of Health Organization and Medical Management, Moscow, Russian Federation

Background and Aims: In some cases the KG’s storage solution turns out to be contaminated. This asymptomatic donor’s bacteremia can threat to recipient’s health and life, because of leading to various infectious complications. Moreover, primary graft infection is detected several days after surgery. The aim: to explore options for the clinical course and outcomes after primary-infected kidney transplantation.

Methods: we analyzed 1633 KTx. 72 cases of primary-infected renal allograft (PIRAG) transplantation were identified. All PIRAG’s recipients were initially prescribed immunosuppressive therapy (IST) and antibacterial prophylaxis with 3d gen of cephalosporins. The bacteriological research results were obtained on the 3-7 day after KTx. Having a positive result, the therapy was immediately adjusted according to the individual sensitivity of infection to antibiotics.

Results: In 47.2% cases, the Gram+ or - flora had been detected. Mixed infection - in 4.2% cases. Yeast fungi - in 1.4% cases. There were no any infectious complications in 72.2% of PIRAG cases. In 16.7% the development of local and/or generalized purulent-septic complications with the development of sepsis had been noted immediately (on 2-5 days after KTx). In such cases, emergency nephrotransplantectomy, revision, sanitation and drainage of infected areas were performed. Antibiotic therapy was prescribed, IST was canceled, and intravenous administration of human immunoglobulin was used. In cases of arrosive bleeding from the vessel’s anastomoses we performed the recipient’s external iliac artery and vein resection with simultaneous cross-iliac-femoral shunting. In 11.1% delayed complications with satisfactory graft’s function had been manifested.

Conclusion: PIRAG is an undoubted factor of septic complication’s development in kidney recipients. While PIRAG detected, the immediate antibacterial therapy maximization is necessary, with its correction according to microflora’s sensitivity to antibiotics.

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