Clinical impact of culture-positive preservation fluid on solid organ transplantation: A systematic review and meta-analysis.Oriol I, Sabe N, et al.
Transplantation Reviews 2018;32(2):85-91
To conduct a systematic review and meta-analysis to assess the incidence of culture-positive preservation fluid (PF) and the impact of this on solid organ transplant (SOT) recipients.
The databases Medline, Web of knowledge, Cochrane Library, Scopus and Science Direct were searched by two independent reviewers until September 2016 for relevant full-text articles published in English, Spanish or French that assessed the etiology, incidence and clinical impact of PF contamination in SOT recipients. Two reviewers independently extracted data from included studies and carried out the quality assessment using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies.
17 studies were included in the analysis.
Measured outcomes included the incidence of culture-positive PF, culture positive PF by pathogenic microorganisms or saparophtic flora, PF-related infections including among SOT recipients receiving and not receiving pre-emptive antibiotic treatment, and mortality among PF-related infections.
This systematic review searched several databases and two authors conducted the process of sifting references and extracting data. As expected, the majority of studies are retrospective, but I do not think this should detract from all of the conclusions made. The quality assessment was also conducted in duplicate but is not presented in this paper unfortunately. The authors found an overall culture-positive rate of 37%, which seems high, although the authors feel the real rate will be higher. It was as high as 85% when looking at just prospective studies, which may have something to do with more intensive culture processes used in these studies. The culture-positive rate with pathogenic microorganisms was 13%. The overall rate of culture-related infection was 4%, which is much harder to give weight to, as records are more likely to be patchy. When pathogenic organisms were cultured, the perfusion fluid infection rate was reduced by pre-emptive antibiotic treatment. The recorded perfusion fluid infection-related mortality rate was 35%, which seems high; only 36 individuals were in this category and the authors acknowledge difficulties in attributing this result. Overall it seems that contamination is frequent, however the incidence of subsequent infection is low. Pre-emptive treatment can reduce subsequent infection risk in the setting of pathogenic microorganisms and fungi but was not statistically significant in this study.
Quality assessment not appropriate
PROSPERO - 42017064017