Fifty‐one cases of fungal arteritis after kidney transplantation: A case report and review of the literature

Abstract

Fungal arteritis affecting graft arteries is a rare but life-threatening complication in kidney transplantation (KT). Here, we report the case of a patient with Aspergillus arteritis who experienced renal artery rupture 8 days after KT. We also reviewed 50 other reported cases of fungal arteritis after KT. We found that fungal contamination can occur during kidney graft harvest, preservation, and/or transplantation. Typically, early diagnosis, timely antifungal treatment, and emergency surgery seem crucial for avoiding life-threatening vascular complications.

Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation: do we pay higher risk of severe infection after transplantation?: a case report

“…On the other hand, the case of our patient shed light on the potential risk of fungal or E.coli ESBL infections using DCD managed with ECMO and ex-vivo perfusion [10,21,22]. In this setting an antifungal prophylaxis may be suggested, even if cultures from donor's blood and from preservation fluids result negative.…”

The Case | Knee pain and allograft dysfunction in a kidney transplant recipient

“…1 Candida arteritis typically presents within 3 months after kidney transplantation with abdominal pain, hemorrhagic shock, and/or fever. 1,2 Our case is unique in that our patient presented with an embolic complication, that is, septic arthritis due to hematogenous spread to the lower extremity joints. Two studies of graft-site candidiasis and fungal arteritis in kidney transplant recipients noted positive blood cultures in a minority of cases.…”

“…More than 80% of patients require graft nephrectomy. 1,2 Graft-site candidiasis has been associated with organ contamination during procurement as a result of donor intestinal tract rupture and/or receipt of broad-spectrum antibiotics leading to intestinal Candida colonization. 1,2 Routine fungal culture of organ preservation fluid with targeted antifungal therapy for positive results is suggested to mitigate vascular complications.…”

“…1,2 Graft-site candidiasis has been associated with organ contamination during procurement as a result of donor intestinal tract rupture and/or receipt of broad-spectrum antibiotics leading to intestinal Candida colonization. 1,2 Routine fungal culture of organ preservation fluid with targeted antifungal therapy for positive results is suggested to mitigate vascular complications. 1,2 However, approximately 25% of organ preservation fluid cultures are positive for pathogenic organisms, and yet, for unknown reasons, the incidence of preservation fluid-related infection is only 1.3%.…”

“…1,2 Routine fungal culture of organ preservation fluid with targeted antifungal therapy for positive results is suggested to mitigate vascular complications. 1,2 However, approximately 25% of organ preservation fluid cultures are positive for pathogenic organisms, and yet, for unknown reasons, the incidence of preservation fluid-related infection is only 1.3%. 3 Direct donor-to-host transmission is uncommon as a result of extensive deceased donor microbiologic screening.…”