Canaud Guillaume, Timsit Marc-Olivier, Zuber Julien, Bougnoux Marie-Elisabeth, Méjean Arnaud, Thervet Eric, Snanoudj Renaud, Sberro Rebecca, Martinez Frank, Legendre Christophe, Mamzer-Bruneel Marie-France
Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France.
Nephrol Dial Transplant. 2009 Apr;24(4):1325-7. doi: 10.1093/ndt/gfn622. Epub 2008 Nov 11.
Fungal contamination of kidney allograft preservative fluid can lead to renal arteritis and arterial wall rupture.
We have evaluated a conservative management strategy based onearly antifungal therapy, rigorous morphological monitoring of the graft artery and surgical second look (SSL). Since November 2004, preservative fluid was routinely cultured on specific media for all kidney transplant recipients.
In 8/474 cases, results were positive for Candida (albicans 5, glabrata 2, tropicalis 1). Two patients also had candida infection of drainage fluid leading to the diagnosis of operative site infection. Radiological and surgical examinations of the renal graft artery were normal in all cases and nephrectomy was not required. At 12 months, all patients were alive with a functioning allograft.
Early antifungal therapy with microbiological and morphological follow-up should be recommended as soon as contamination is detected, but SSL is advised only in patients with risk factors for arterial anomalies.
肾移植保存液的真菌污染可导致肾动脉炎和动脉壁破裂。
我们评估了一种基于早期抗真菌治疗、对移植肾动脉进行严格形态学监测以及手术二次探查（SSL）的保守管理策略。自2004年11月起，对所有肾移植受者的保存液常规在特定培养基上进行培养。
在474例病例中的8例，念珠菌培养结果呈阳性（白色念珠菌5例，光滑念珠菌2例，热带念珠菌1例）。2例患者引流液也有念珠菌感染，导致手术部位感染的诊断。所有病例中肾移植动脉的影像学和手术检查均正常，无需进行肾切除术。在12个月时，所有患者均存活，移植肾功能良好。
一旦检测到污染，应建议尽早进行抗真菌治疗并进行微生物学和形态学随访，但仅建议对有动脉异常危险因素的患者进行手术二次探查。
