Loss of renal allografts secondary to Candida vascular complications in two recipients from the same donor

Abstract

Infections remain a major cause of morbidity and mortality in transplant patients. Organ recipients are also susceptible to donor-derived pathogens and the majority of donor infections are easily treatable. Rarely, some pathogens have produced life-threatening complications by compromising the vascular anastomosis. In this case series we report loss of two kidney allografts secondary to vascular complications due to Candida albicans. Both recipients received grafts from a common donor, in whom Candida bacteremia in the donor was not apparent at the time of organ acceptance but became apparent on delayed cultures.

Figure 1

A possible pseudoaneurysm in the region of the vascular anastomosis revealed by Color Doppler Ultrasound (a) with an area of turbulent and to-and-fro waveforms. Follow-up MRI (b) confirmed a bilobed pseudoaneurysm (white arrow) and revealed a segment of high-grade stenosis of the right external iliac artery (red arrow). Conventional angiogram image (c) in AP view reconfirmed the pseudoaneurysm (white arrow) and a segment of high-grade stenosis of the right external iliac artery (red arrow) with stenosis of the transplanted renal artery (green arrow).

Figure 2

Pathological examination of explant revealed renal artery and intraparenchymal arterial branches positive for fungal organisms by GMS stain.