Calviño J, Romero R, Pintos E, Novoa D, Mardaras J, Arcocha V, Lens X M, Sanchez-Guisande D
Department of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain.
Am J Kidney Dis. 1999 Jan;33(1):E3. doi: 10.1016/s0272-6386(99)70292-1.
Infected graft transplantation is an unwelcome complication that may lead to serious consequences in the immunosuppressed host. It can be caused by infection of the donor or by contamination of the organ during harvest, preservation and handling, or at transplantation. With current donor evaluation protocols, the risk of transmitting infections by exogenous contaminated grafts seems to be more frequent than true donor-transmitted infections. Nevertheless, although rare and usually free of clinically significant sequelae, if contamination is by some virulent organisms such as Staphylococcus aureus, gram-negative bacilli, or fungi, severe complications may occur. We report the clinical outcome of liver, heart, and kidney recipients from a single donor. Both renal allografts had to be removed because of renal artery rupture secondary to Candida albicans infection. Careful donor evaluation before transplantation, unusually early presentation of mycosis leading to anastomotic renal artery disruption, the histopathologic findings of the grafts, and the absence of Candida infection in the liver and heart recipients make us believe that exogenous contamination of the grafts occurred during donor procedure, kidney processing, or at transplantation. In summary, because infected grafts can lead to serious complications, besides careful donor screening, it is important to achieve early recognition of contaminated organs by culturing the perfusate to start specific antibiotic or antifungal therapy after transplantation if necessary and avoid the rare but, in this case, fatal consequences of these infections.
感染性移植物移植是一种不良并发症，可能在免疫抑制宿主中导致严重后果。它可由供体感染或器官在获取、保存、处理过程中或移植时受到污染引起。根据目前的供体评估方案，外源性污染移植物传播感染的风险似乎比真正由供体传播的感染更为常见。然而，尽管罕见且通常无临床显著后遗症，但如果污染是由一些毒性较强的微生物如金黄色葡萄球菌、革兰氏阴性杆菌或真菌引起的，可能会发生严重并发症。我们报告了来自单一供体的肝、心、肾移植受者的临床结果。由于白色念珠菌感染继发肾动脉破裂，两个肾移植均不得不被切除。移植前对供体进行仔细评估、真菌病异常早期出现导致吻合口肾动脉破裂、移植物的组织病理学发现以及肝和心移植受者中无念珠菌感染，使我们认为移植物的外源性污染发生在供体操作、肾脏处理过程中或移植时。总之，由于感染性移植物可导致严重并发症，除了仔细筛选供体外，通过对灌注液进行培养以早期识别受污染器官非常重要，以便在必要时在移植后开始特定的抗生素或抗真菌治疗，并避免这些感染罕见但在本例中致命的后果。
