Carbapenem-resistant Klebsiella pneumoniae infection causing rupture of graft artery in solid organ recipients: Case report and review of literature

Abstract

Rationale: Donor-derived bacterial infection is a rare cause of morbidity after solid organ transplantation (SOT) but associated with significant morbidity and mortality, deaths caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) infection account for a considerable proportion of postoperation mortality rate in liver and kidney recipients. The arterial rupture as a result of fungal arteritis is occasionally described, while the rupture of graft vascular anastomosis after SOT due to donor-derived CRKP infection is rarely reported.

Patients concerns: We reported 1 patient with donor-derived CRKP infection following liver transplantation and 2 patients following renal transplantation (1 liver and 2 kidneys were from the same donor), who experienced sudden abdominal pain and abdominal hemorrhage almost at the same time after organ transplantation.

Diagnosis: The patients were diagnosed as graft arteries rupture due to corrosion caused by CRKP infection based on computed tomography scan, blood culture, laparotomy, and pulse-field gel electrophoresis.

Interventions: Anti-shock treatment, exploratory laparotomy, broad-spectrum antibiotics, and abdominal puncture and drainage were given.

Outcomes: The liver recipient survived as well as the liver graft, still under treatment of multiple abdominal infections. The 2 renal recipients were alive after resection of the renal grafts and underwent hemodialysis.

Lessons: Rupture of graft artery should be foreseen when donor-derived CRKP infection was confirmed and broad-spectrum antibiotics and other interventions need to be considered.

Figure 1

Pulsed-field gel electrophoresis analysis of total DNA of CRKP from donor and 3 recipients isolates. A, B, C, D: restriction patterns are from CRKP isolates from culture of PV blood from donor (A), liver abscess from recipient 1 (B), peripheral blood from recipient 2 (C), and surgical site sample from recipient 3 (D). CRKP = carbapenem-resistant Klebsiella pneumoniae.

Figure 2

liver recipient (recipient 1). (A) Enhanced total abdomen CT scan revealed the thrombosis of hepatic artery and massive liver necrosis 14 days after liver transplantation. (B) Reduction in sizes of liver abscesses after percutaneous peritoneal drainage 2 months following liver transplantation. (C) Significant reduction in sizes of liver abscess 7 months after liver transplantation. (D) Enlarged portal vein and numerous branches 7 months after liver transplantation. CT = computed tomography.

Figure 3

Two renal recipients (recipient 2, 3). (A) CT scan showed massive fluid collection in the perigraft area 14 days after renal transplantation in recipient 2. (B) Iliac artery angiopathy found the bleeding of renal artery anastomosis 14 days after renal transplantation in recipient 2. (C) Enhanced CT scan revealed the right iliac abscess 75 days after resection of renal allograft in recipient 2. (D) Resection renal allograft with corroded artery end 13 days after renal transplantation in recipient 3. (E) Endovascular covered stent placed in the left external iliac artery 13 days after transplantation in recipient 3. CT = computed tomography.