2024, Number 4
Arterial anastomosis rupture as an early complication secondary to invasive infection of the kidney graft by Candida albicans
Mondragón-Salgado C, Carrillo-Vidales J, González-García I, Martínez-Cabrera C, Vilatobá M, Laparra-Escareño H, Santos-Chávez E, Navarro-Iñiguez J, Barragán-Galindo L, Morales-Guillén M, García-Sánchez C, Morales-Buenrostro L, Uribe-Uribe N, Burbano-Rodríguez S, Jiménez-Hernández M, Rivera-Salazar M, Cruz-Martínez R
Full text
10.35366/119297
Language: Spanish
References: 7
Page: 178-183
PDF size: 467.01 Kb.
ABSTRACT
Introduction: graft function and survival in postransplant recipients are compromised in cases of invasive Candida sp. infection due to abrupt presentation and nonspecific symptoms. Approximately 1.3% of recipients will develop invasive fungal infection, 49% secondary to Candida albicans, followed by C. glabrata and parapsilosis. It is transmitted from donor to recipient in 0.001% of cases, only 65.4% receive antifungal treatment in the presence of positive perfusion fluid cultures. The incidence of invasive candidiasis is 0.001%, independent risk factors for C. albicans infection have not yet been identified. There are few reported cases of persistent infection and failure of vascular reconstruction after graft nephrectomy. Case report: 24-year-old female patient, diagnosed with lupus nephropathy, received a cadaveric donor kidney transplant without complications. Pre-transplant urine culture was positive for C. albicans, interpreted as contamination. The donor (21 years old, KDRI 0.66/KDPI 13%) presented pyelocaliceal dilatation due to probable ureteral stenosis, repaired during bank surgery. At 14 days he suddenly presented hypovolemic shock, the surgical exploration reported complete dehiscence of the arterial anastomosis with extension to the renal hilum. Graft nephrectomy and vascular reconstruction of the external iliac artery with PTFE patch was performed. The pathology of the graft reported hydronephrosis and acute/chronic granulomatous pyelonephritis associated with filamentous fungus, suggestive of Candida sp. Nine days later she presented sudden hypovolemic shock and cardio-respiratory arrest, open vascular exploration was performed, reporting PTFE patch dehiscence, external iliac artery resection was performed and distal vascular reconstruction with PTFE femoro-femoral bridge (banded, 10 mm), confirming Candida albicans invasion by histopathology and cultures. He started anidulafungin, was adjusted to Fluconazole, completing six weeks of treatment. Two months of follow-up without recurrence. Discussion: invasive infection by Candida sp. frequently presents unfavorable outcomes with any type of treatment in terms of graft and patient survival. Few cases require additional interventions due to persistence of the infection. Trans-surgical macroscopic assessment does not correlate with the degree of infection, so it is difficult to determine the extent of resection. Even with the risk of contamination of the synthetic vascular material, adequate short-term success rates have been reported. Conclusion: aggressive surgical treatment could improve patient survival outcomes. Performing native vessel resection and distal revascularization initially could be a valid option in selected cases. We should not underestimate the impact of positive pretransplant cultures, even in the absence of symptoms. It is recommended to send native tissue samples to rule out residual candidiasis. Close follow-up is required when using synthetic materials for vascular reconstruction. A consensus has yet to be reached to determine the best management for cases of invasive candidiasis and thus improve outcomes in terms of graft function, due to the high rate of nephrectomies performed.REFERENCES