Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 912-921
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.912
Allograft artery mycotic aneurysm after kidney transplantation: A case report and review of literature
Marco Bindi, Mariano Ferraresso, Maria Letizia De Simeis, Nicholas Raison, Laura Clementoni, Serena Delbue, Marta Perego, Evaldo Favi
Marco Bindi, Mariano Ferraresso, Maria Letizia De Simeis, Laura Clementoni, Marta Perego, Evaldo Favi, Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
Mariano Ferraresso, Evaldo Favi, Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
Nicholas Raison, MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
Serena Delbue, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20100, Italy
Author contributions: Bindi M contributed to the data collection, literature review, drafting the article, and final approval; Ferraresso M contributed to performing the procedure, critical revision, and final approval; De Simeis ML contributed to the data collection, editing the article, and final approval; Raison N drafted the article, made language revisions, and final approval; Clementoni L contributed to data collection, editing the article, and final approval; Delbue S made critical revision, and final approval; Perego M contributed to the data collection, editing the article, and final approval; Favi E contributed to performing the procedure, conception of the study, literature review, drafting the article, critical revision, and final approval.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors do not have any conflicting interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Evaldo Favi, MD, PhD, Senior Lecturer, Surgeon, Consultant in Transplant and Vascular Access Surgery, Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza n. 28, Milan 20122, Italy. evaldofavi@gmail.com
Received: November 25, 2019
Peer-review started: November 25, 2019
First decision: January 7, 2020
Revised: January 8, 2020
Accepted: February 15, 2020
Article in press: February 15, 2020
Published online: March 6, 2020
Processing time: 101 Days and 20.4 Hours
Abstract
BACKGROUND

Allograft artery mycotic aneurysm (MA) represents a rare but life-threatening complication of kidney transplantation. Graftectomy is widely considered the safest option. Due to the rarity of the disease and the substantial risk of fatal consequences, experience with conservative strategies is limited. To date, only a few reports on surgical repair have been published. We describe a case of true MA successfully managed by aneurysm resection and arterial re-anastomosis.

CASE SUMMARY

An 18-year-old gentleman, on post-operative day 70 after deceased donor kidney transplantation, presented with malaise, low urinary output, and worsening renal function. Screening organ preservation fluid cultures, collected at the time of surgery, were positive for Candida albicans. Doppler ultrasound and contrast-enhanced computer tomography showed a 4-cm-sized, saccular aneurysm of the iuxta-anastomotic segment of the allograft artery, suspicious for MA. The lesion was wide-necked and extended to the distal bifurcation of the main arterial branch, thus preventing endovascular stenting and embolization. After multidisciplinary discussion, the patient underwent surgical exploration, aneurysm excision, and re-anastomosis between the stump of the allograft artery and the internal iliac artery. The procedure was uneventful. Histology and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida infection. Three years after the operation, the patient is doing very well with excellent allograft function and no signs of recurrent disease.

CONCLUSION

Surgical repair represents a feasible option in carefully selected patients with allograft artery MA. Anti-fungal prophylaxis is advised when preservation fluid cultures are positive.

Keywords: Aneurysm; Candida; Kidney transplant; Infection; Complication; Case report

Core tip: Fungal infections transmitted by contaminated organs represent an important source of complications after kidney transplantation. Among the others, allograft artery mycotic aneurysm (MA) deserves a special consideration as it may cause transplant loss and death. Elective management of non-complicated MA is controversial. For many years, graftectomy has been considered the only reasonable option. However, recent reports have shown that in carefully selected patients, surgical repair can offer excellent results. We herein describe a rare case of true MA of the transplant artery caused by Candida albicans and successfully treated by aneurysm resection and re-anastomosis.