Abstract: FR-PO775
Concern for Donor-Derived Candidiasis Causing a Mycotic Aneurysm in the Transplanted Renal Artery
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Shah, Sapna, University of California System, Oakland, California, United States
- Voora, Santhi, University of California System, Oakland, California, United States
- Maw, Thin Thin, University of California System, Oakland, California, United States
Introduction
Donor-derived infections can be associated with dire consequences in transplant recipients. Although extremely rare, fungal infections in renal allografts can result in renal arteritis, urinoma, graft site abscess, and surgical site infection. We present a clinical case of a mycotic aneurysm secondary to Candida krusei infection in a kidney transplant recipient.
Case Description
A 75 year old male with end stage kidney disease secondary to presumed diabetic nephropathy underwent a deceased donor kidney transplantation. At the time of transplantation the donor was noted to have untreated candida species isolated from both urine and sputum. His post-operative course was complicated by delayed graft function and post-operative myopathy. On POD 11 he was found unresponsive and pulseless in his hospital bed. Chest compressions were emergently initiated with return of spontaneous circulation. Labs were notable for new lactic acidosis, acute anemia, and hyperkalemia. CT scans of his abdomen and pelvis were obtained and notable for a large pelvic hematoma with active extravasation. He underwent emergent re-exploration of his kidney transplant and was found to have a 23 cm hematoma, and a necrotic posterior wall of his main renal artery with concern for a ruptured mycotic aneurysm (Figure 1). Both fungal and surgical cultures were positive for Candida krusei. He was initiated on Micafungin and then transitioned to Voriconazole with subsequent clearance of his fungemia after 6 weeks of therapy. Following this event he has had prolonged delayed graft function.
Discussion
Allograft artery mycotic aneurysm is an extremely rare and life-threatening complication that can develop following kidney transplantation. A high index of suspicion is needed to make the correct diagnosis of Candida associated mycotic aneurysms due to its insiduous presentation.
Figure 1: CT Abdomen with extravasation from transplanted renal artery