© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Clin Transplant 2015: 29: 99–100 DOI: 10.1111/ctr.12485

Clinical Transplantation

Letter to the Editor

Comparison of bacterial contamination between transvaginalassisted laparoscopic donor nephrectomy and conventional donor nephrectomy Transvaginal extraction after laparoscopic donor nephrectomy obviates the need for extraction incision thereby reducing pain and early return to normal activity (1, 2). A pre-operative vaginal swab was performed and gram staining, and bacterial culture and fungal cultures were obtained. Donors who had normal flora by Nugent’s criteria were included (3). Donors with positive vaginal culture with a pathogenic bacteria were excluded. Donors were advised to apply povidone iodine vaginal pessary (200 mg) one d prior to the surgery and to continue for five d. Donors were administered one gram of cefotaxime and 500 mg of metronidazole prior to the surgery and continued for two doses. The recipients were administered 1.5 g of cefipime, 1 g and 500 mg metronidazole for five d. In transabdominal group, hand was inserted through a Pfannensteil incision of size 5–7 cm, while in the transvaginal group, retrieval bag (Retrieval bag comfort; Aesculap, Tuttlingen, Germany) was introduced through the vagina for extracting the kidney. Subsequent to extraction, multiple swabs were obtained from the kidney surface and from

extraction bag. Bacterial culture was performed using blood and MacConkey agars. In the event there is growth of bacteria, differentiation between commensals and pathogens was made using colony morphology and gram stain. The pathogens are then submitted for various biochemical reactions for further identification. The antibiotic susceptibility test was performed using Muller–Hinton agar (Sigma Aldrich Corp, St. Louis, MO, USA). Yeast identification was carried out utilizing hi chrome agar (Sigma Aldrich Corp) and Fungitest kit (BioRad Inc, Hercules, CA, USA) was used for sensitivity. More than 102 colony count was considered to be significant. The microbiological contamination and infection rate were compared between 40 cases each of transabdominal extraction and transvaginal groups during the same time period. The statistical analysis was performed using Student’s t test and Fisher’s exact test. Forty-four donors consented for the study, of which four donors were excluded because of positive vaginal culture (Table 1). Among the culture positive donors, three had coagulase-positive

Table 1. Comparison between patients with LDNTVE and LDNTAE

Mean age Males Females Wound infection donor Vaginal cuff infection Wound infection recipient Urinary tract infection recipient at six wk Other infectious complication Mean eGFR after six months Graft loss at six months Recipient mortality at six months

Transvaginal extraction (n = 40)

Transabdominal (n = 40)

41  6 0 40 0 0 1 1 3 56  9 1 2

39  8 23 17 0 NA 2 2 4 59  11 0 1

p values 0.20

1.0 1.0 1.0 1.0 0.18 1.0 1.0

LDNTVE, laparoscopic donor nephrectomy with transvaginal extraction; LDNTAE, laparoscopic donor nephrectomy with transabdominal extraction.

99

Letter to the Editor

Staphylococcus aureus and one grew Candida. There were three cases of Pseudomonas fluorescence growth from the cultures on kidney surface, one of which was in the transvaginal group and the other two were in the transabdominal group. Later, this was proved to be a contaminant from the water system in the hospital during a particular time period. Cultures from the surface of the retrieval bag were negative in all 40 cases of LDNTVE. There was no wound infection/vaginal cuff in the transvaginal group. There were two cases of wound infection with Escherichia coli in the recipients in the transabdominal group, while in the transvaginal group, there was one case of florid infection with Group A Streptococcus on the eighth post-operative day. This patient had a hyperacute rejection prior to the onset of wound infection and eventually, the graft was lost. Two patients in each group developed E. coli infection in the first six months. One case of Klebsiella pneumonia and two cases of cytomegalovirus (CMV) infections were seen in the transvaginal group over a period of six months. In the transabdominal group, there were two cases of CMV infection, one case of aspergilloma and one patient had cellulitis of the leg with S. aureus. Overall, no significant difference in infection rates were found in both

100

groups. Our study proves that with proper patient selection, adequate preparation and antibiotic coverage, LDNTVE can safely be performed. Kishore Thekke Adiyata, Abijit Shettya, Pabithra Kumar Mishraa, Nidhi Bansalb, Karipparambath Vinodanc and Suresh Bhatd a Department of Urology, Medical Trust Hospital, Cochin, bDepartment of Microbiology, Medical Trust Hospital, Cochin, cDepartment of Anesthesiology, Medical Trust Hospital, Cochin and dDepartment of Urology, Government Medical College, Kottayam e-mail: [email protected] References 1. ALCARAZ A, MUSQUERA M, PERI L et al. Feasibility of transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy: is kidney vaginal delivery the approach of the future? Eur Urol 2010: 57: 233. 2. KISHORE TA, SHETTY A, BALAN T et al. Laparoscopic donor nephrectomy with transvaginal extraction: initial experience of 30 cases. J Endourol 2013: 27: 1361. 3. NUGENT RP, KROHN MA, HILLIER SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991: 29: 297.

Comparison of bacterial contamination between transvaginal-assisted laparoscopic donor nephrectomy and conventional donor nephrectomy.

Comparison of bacterial contamination between transvaginal-assisted laparoscopic donor nephrectomy and conventional donor nephrectomy. - PDF Download Free
64KB Sizes 0 Downloads 9 Views