Abstract: PUB542
Kidney Transplant Candidacy in a Patient with Recurrent Infection: Balancing Improved Quality of Life vs. Potential Infection Risk
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Quizon, Marrey Ruby L., UCI Health, Orange, California, United States
- Tantisattamo, Ekamol, UCI Health, Orange, California, United States
Introduction
In the field of kidney replacement therapy, the definitive management is kidney transplant (KT). While recurrent infection is generally a contraindication for KT, a balance between improved quality of life from KT and increased risk of post-transplant infection can be justified. We report a case of man with recurrent soft tissue infections above the arteriovenous fistula (AVF) site who underwent KT and subsequent AVF removal for infection source control.
Case Description
A 57-year-old man with ESKD who underwent a deceased donor kidney transplant (DDKT) 2 months prior was admitted for management of purulent cellulitis on his left arm AVF. For the past few years, he had chronic issues with this fistula including thrombosis requiring stent placement. He also had episodes of nonpurulent cellulitis over an area of the AVF, managed by vancomycin courses during his dialysis sessions. These episodes had occurred every 3-4 months for the past year. He was originally planned for AVF revision to eliminate infection source, but he received a kidney offer and underwent DDKT. The AVF revision was postponed with a plan to be addressed six months post-transplant. However, around two months post-transplant, he again developed cellulitis over the AVF, but now with purulence. Given the severity of infection in the setting of immunosuppressed state, AVF ligation and removal of the underlying infected stent was performed. He had no systemic symptoms and blood cultures were negative. He recovered well and was discharged with intravenous antibiotics.
Discussion
Our patient had recurrent soft tissue infections over his AVF, suggesting bacterial seeding of the stent or refractory skin infection and failed antimicrobial treatment. While KT improved his survival and quality of life, post-transplant immunosuppressed state contributed to a more severe purulent form of his usual cellulitis overlying a high-flow vascular access, which, while fortunately did not occur for him, may increase the risk of bacteremia and associated systemic sequelae. Patients with a history of prior infection should receive close monitoring and definitive treatment to get rid of the source of recurrent infections ideally prior to KT. However, KT while the infection is controlled and then followed by infection source elimination can be considered in selected patients.