Evidence That Graft-Site Candidiasis after Kidney Transplantation Is Acquired during Organ Recovery: A Multicenter Study in France

Background.Infections of renal grafts with Candida species can induce life-threatening complications in the recipient. Methods.A 9-year retrospective study involving all of the transplant centers in France was designed to determine the incidence, origin, characteristics, and outcome of graft-site ca...

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Bibliographic Details
Published in:Clinical infectious diseases 2009-01, Vol.48 (2), p.194-202
Main Authors: Albano, Laetitia, Bretagne, Stéphane, Mamzer-Bruneel, Marie-France, Kacso, Irina, Desnos-Ollivier, Marie, Guerrini, Patrice, Le Luong, Thanh, Cassuto, Elisabeth, Dromer, Françoise, Lortholary, Olivier
Format: Article
Language:English
Subjects:
Adult
Aged
Aneurysms
Antifungals
Arteritis
Articles and Commentaries
Biological and medical sciences
Candida
Candida - classification
Candida - genetics
Candida - isolation & purification
Candida albicans
Candidiasis
Candidiasis - epidemiology
Candidiasis - etiology
Cultural preservation
Female
France
France - epidemiology
Genotype
Genotype & phenotype
Humans
Incidence
Infections
Infectious diseases
Kidney diseases
Kidney Transplantation
Kidney Transplantation - adverse effects
Kidneys
Life Sciences
Male
Medical sciences
Microbiology and Parasitology
Middle Aged
Organ donation
Retrospective Studies
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Tissue grafting
Transplantation
Transplants & implants
Treatment Outcome
Vascular grafting
Yeast
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Summary:Background.Infections of renal grafts with Candida species can induce life-threatening complications in the recipient. Methods.A 9-year retrospective study involving all of the transplant centers in France was designed to determine the incidence, origin, characteristics, and outcome of graft-site candidiasis that occurred after kidney transplantation. Yeasts cultured from preservation or drainage solutions and graft specimens were recorded. Results.Among 18,617 kidney grafts, 18 recipients corresponding to 12 donors developed culture-confirmed graft-site candidiasis (incidence, 1 case per 1000 grafts) a median of 25 days after the graft procedure. Clinical presentations included 14 cases of renal arteritis (13 were complicated by aneurysm), 1 urinoma, 2 graft site abscesses, and 1 surgical site infection. Candida albicans was involved in 13 cases. A unique C. albicans genotype or a single rare Candida species was involved in each episode. Together with the clinical history, these findings demonstrate that organ contamination followed by transmission to the recipient occurred during recovery. Therapeutic management varied from simple monitoring in 1 case to a combination of surgery (nephrectomy in 9 cases and arterial bypass in 9 cases) and antifungal therapy (14 cases). Overall, 3 of 18 kidney transplant recipients died, and 9 had their graft surgically removed. Conclusion.Graft-transmitted candidiasis that ends most often in fungal arteritis is associated with high morbidity and mortality after kidney transplantation and is related to organ contamination during recovery in the donor.
ISSN:1058-4838
1537-6591
DOI:10.1086/595688