Dębska-Ślizień A, Chrobak Ł, Bzoma B, Perkowska A, Zadrożny D, Chamienia A, Kostro J, Milecka A, Bronk M, Śledziński Z, Rutkowski B
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Department of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warszawa, Poland.
Transpl Infect Dis. 2015 Jun;17(3):449-55. doi: 10.1111/tid.12388. Epub 2015 May 26.
Multi-organ procurement is a risk factor for contamination of preservation fluid with intestinal flora including fungi (e.g., Candida). Transmission of fungal species to the graft vessel can cause mycotic arteritis. This is a very rare but life-threatening complication of renal transplantation. We present 2 cases of renal transplant recipients from the same multi-organ donor. Both recipients suffered from severe hemorrhages from renal graft anastomosis and renal artery pseudoaneurysm due to Candida albicans arteritis (CAA). The culture of the preservation fluid revealed growth of Escherichia coli, but neither preservation fluid nor multiple routine blood cultures performed before hemorrhagic complications revealed fungal growth (media non-selective for fungal growth were applied). The first recipient suffered from sudden severe hemorrhage in the area of graft anastomosis on day 10 post surgery (without any preceding clinical or radiological symptoms). This led to urgent surgery and graftectomy, which was complicated by cardio-respiratory arrest with resuscitation in the operating room; despite resuscitation, irreversible brain damage, and subsequent death occurred in the intensive care unit (ICU) 2 weeks later (on day 24 after transplantation). The second patient underwent urgent vascular surgery on day 22 (after transplantation), because of hemorrhage from a pseudoaneurysm of the graft artery. She required repeated vascular operations, extended antimicrobial and antifungal therapy, and ICU monitoring and, despite these interventions, she died on day 80 after transplantation as a result of Pseudomonas aeruginosa sepsis. Arteritis of the renal artery in both patients was caused by C. albicans. This was confirmed by histopathology: infiltration of renal artery with budding yeast forming pseudohyphae (Case 1), and the presence of C. albicans in the culture of the renal artery and surrounding tissue (Case 2). We conclude that organ preservation solution should be cultured with use of media selective for fungal growth. As soon as the positive culture is detected, appropriate measures protecting patients against CAA should be undertaken.
多器官获取是保存液被包括真菌（如念珠菌）在内的肠道菌群污染的一个风险因素。真菌物种传播至移植血管可导致霉菌性动脉炎。这是肾移植中一种非常罕见但危及生命的并发症。我们报告了2例来自同一多器官供体的肾移植受者。两名受者均因白色念珠菌动脉炎（CAA）导致肾移植吻合口严重出血和肾动脉假性动脉瘤。保存液培养显示有大肠杆菌生长，但在出血并发症发生前进行的保存液及多次常规血培养均未显示有真菌生长（使用的是对真菌生长无选择性的培养基）。第一名受者在术后第10天移植吻合口区域突然发生严重出血（无任何先前的临床或影像学症状）。这导致了紧急手术和移植肾切除术，术中并发心肺骤停并在手术室进行了复苏；尽管进行了复苏，但2周后（移植后第24天）在重症监护病房（ICU）发生了不可逆的脑损伤并随后死亡。第二名患者在移植后第22天因移植动脉假性动脉瘤出血接受了紧急血管手术。她需要反复进行血管手术、延长抗菌和抗真菌治疗以及ICU监测，尽管采取了这些干预措施，但她在移植后第80天因铜绿假单胞菌败血症死亡。两名患者的肾动脉炎均由白色念珠菌引起。这通过组织病理学得到证实：肾动脉有形成假菌丝的芽生酵母浸润（病例1），以及在肾动脉和周围组织培养中发现白色念珠菌（病例2）。我们得出结论，器官保存液应使用对真菌生长有选择性的培养基进行培养。一旦检测到阳性培养结果，就应采取适当措施保护患者免受CAA的影响。
