Mycotic Aneurysm of Transplant Renal Artery

Introduction: Kidney transplant recipients are at risk for infectious complications of surgery during the first three months after transplantation. Fungal infections, though rare, affect 0.1% to 5% of kidney transplant recipients. Herein, we present a case of a transplant recipient who developed a ruptured mycotic aneurysm that led to a transplant nephrectomy. Case Description: A 72-year-old man with end-stage kidney disease from hypertension and type two diabetes underwent a deceased donor kidney transplant. He presented to the emergency department 22 days after transplantation with a fall. His hemoglobin was 6.1 mg/dl from a baseline of 8.0 mg/dl. A CT of his abdomen revealed a hematoma surrounding the allograft. The hematoma was evacuated and attributed anastomotic dehiscence. The allograft was resected in order to obtain hemostasis, and a patch angioplasty from a saphenous vein was performed. The vessel had a mycotic appearance, prompting the collection of cultures from perinephric fluid and the allograft. The allograft cultures grew Staphylococcus epidermidis, Staphylococcus capitis, Candida tropicalis, and Candida albicans [Figure 1]. Perinephric fluid cultures grew Candida tropicalis and Candida albicans. He was treated with vancomycin and micafungin. Micafungin was switched to fluconazole, which he continued for 4 months due to positive perinephric fluid cultures. His immunosuppressive medications were stopped. Prophylactic trimethoprim-sulfamethoxazole and valacyclovir were continued. Discussion: Mycotic arteritis is a rare complication that leads to graft loss and should prompt an investigation for the source of infection. This patient likely developed the infection de novo, as there were no reports in UNOS of infections in the other organs procured from the donor. Donor organs can be contaminated during procurement, preservation, and intra-operative organ handling. Treatment involves antifungals and allograft nephrectomy.Renal path with candida species