PCR法と振盪培養法(RSC法)による献腎ドナー感染および臓器汚染の迅速診断を行い腎摘出ならびに移植を断念した3ドナーと6献腎の検討

Abstract

献腎提供を承諾した83症例(ドナー)とドナーから摘出した154腎を対象に, polymerase chain reaction(PCR)法と振盪培養(RSC)法による移植前の感染症及び臓器汚染の診断について検討した.その結果, 腎摘出を断念したのは3例で, 摘出後に破棄された腎は6腎(3例)であった.摘出を断念し2例と破棄された腎2腎では, PCR法でmecA, femA両遺伝子を, RSC法でMRSAを検出した.残りの1例では, PCR法で陰性の非特異的バンドを, RSC法で最近の増殖を認め, 定量培養でははbacteroidesが検出された.又, 残りの4腎は, PCR法で18s-rDNA遺伝子を検出し, RSC法で真菌の増殖を認め, 定量培養ではCandidaが検出された

Post transplant infection is one of the serious complications of the organ recipients. We detected the donor infections and allograft contaminations in a limited period of time by polymerase chain reaction (PCR) and rapid shaking culture (RSC). The pre-procurement blood from 86 possible renal donors as well as the preservation solution (PS) and renal pelvic urine (PU) from 158 grafts were examined in order to detect highly virulent organisms such as methicillin resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and fungi. The average age of donors was 48.8 years old. The average period between the admission and brain death was 4.9 days, and the average period between the brain death and cardiac arrest was 3.6 days. The inflammatory indices such as body temperature, white blood cell count and C-reactive protein increased to 37.9 +/- 1.1 degree C, 12, 600 +/- 6300/microl, and 20.2 +/- 11.6 mg/dl, respectively. Following PCR and RSC, procurement operations of the three possible donors were cancelled because of systemic bacterial infections by MRSA or Bacteroides fragilis. Six out of 158 grafts were discarded due to the diagnoses of MRSA or Candida albicans in PS and/or PU. All the other 148 grafts were transplanted. Following transplant, no single infectious complication transmitted by the graft was noted. We conclude that PCR combined with RSC is very accurate and useful for detecting donor infections and allograft contaminations, which may cause severe complications in the recipients.