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Gueneau R, Giret C, Lafont E, Buchler M, Longuet H, Machet MC, Ghazzar N, Lanternier F, Lortholary O. Aspergillus spp. renal arteritis after kidney transplantation: A reappraisal. Transpl Infect Dis 2023; 25:e14108. [PMID: 37504382 DOI: 10.1111/tid.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Aspergillus spp. is an uncommon and life-threatening cause of transplantrenal artery pseudoaneurysm after kidney transplantation. CASE We report the case of a 62-year-old woman who underwent kidney transplantation 10 months before and presented a 7-cm asymptomatic transplant renal artery pseudoaneurysm. Transplanted kidney and pseudoaneurysm were surgically removed in emergency. Renal graft, urine, and pseudoaneurysm cultures grew Aspergillus flavus. She recovered after 12 months of antifungal therapy. LITERATURE REVIEW To date 14 cases of Aspergillus spp. renal arteritis after kidney transplantation have been published, including 50% Aspergillus flavus arteritis. Vast majority were diagnosed within 90 days after transplantation (73%). Despite allograft nephrectomy and antifungal therapy, mortality rate was high (33%).
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Affiliation(s)
- Romain Gueneau
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chloé Giret
- Service de néphrologie, Hypertension, Dialyses, Transplantation, Centre, Hospitalier Régional Universitaire, Tours, France
| | - Emmanuel Lafont
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Buchler
- Service de néphrologie, Hypertension, Dialyses, Transplantation, Centre, Hospitalier Régional Universitaire, Tours, France
| | - Hélène Longuet
- Service de néphrologie, Hypertension, Dialyses, Transplantation, Centre, Hospitalier Régional Universitaire, Tours, France
| | | | - Nadia Ghazzar
- Service de Médecine Nucléaire, Hôpital Européen Georges Pompidou, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
- CNRS, Molecular Mycology Unit UMR 2000, Institut Pasteur, Paris, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
- CNRS, Molecular Mycology Unit UMR 2000, Institut Pasteur, Paris, France
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Hennawy HME, Al-Qahtani S, Faifi ASA, Ghalyoob TM, Khalil HF, Bazeed MF, Atta EA, Safar O, Awad A, Nazer WE, Abdelaziz AA, Mahedy A, Mirza N, Fageeh AA, Elgamal GA, Zaitoun MF, Haddad AE. Successful Endovascular Repair of Infectious External Iliac Artery Anastomotic Pseudoaneurysm With Graft Preservation Post-Kidney Transplantation: Case Report and Review of Literature. Transplant Proc 2022; 54:2709-2715. [PMID: 36786541 DOI: 10.1016/j.transproceed.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Allograft artery-infected pseudoaneurysm (PA) represents a rare but life-threatening complication of kidney transplantation (KT). A review of the literature, showed that nearly all these cases ended resulted in graft loss. We presented a case of post-KT-infected external iliac artery anastomotic PA successfully managed by endovascular stenting with graft preservation. Additionally, we reviewed the pertinent literature. METHOD In this article, we described a hypertensive, 47-year-old man who presented 1 month post-cadaveric KT with acute kidney injury and gram-negative bacteremia secondary to a large infectious anastomotic PA of the external iliac artery. RESULTS Because of favorable anatomy, successful arterial angio-stent fixation of the main renal artery PA, sparing the lower polar artery, was performed after 1 week of antibiotic and fungal coverage. CONCLUSION Patient was discharged after 2 weeks with functioning graft. Graft function was stable after 3 months.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.
| | - Saad Al-Qahtani
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Tayseer M Ghalyoob
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Haytham Fouad Khalil
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia; Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Kasr Al-Ainy St., Egypt
| | - Mohammed F Bazeed
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Eisa Al Atta
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed Awad
- Vascular Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdelaziz A Abdelaziz
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed Mahedy
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Naveed Mirza
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ali Al Fageeh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Galal A Elgamal
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, KSA; Anesthesia Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed El Haddad
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia; Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Management of Transplant Renal Artery Pseudoaneurysm and Literature Review. Case Rep Transplant 2022; 2022:6232586. [PMID: 35726284 PMCID: PMC9206571 DOI: 10.1155/2022/6232586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Renal transplantation is the ultimate treatment for end-stage renal disease patients. However, vascular complications can impact renal allograft outcomes. Extrarenal pseudoaneurysms (EPSA) are a rare complication occurring in 1% of transplant recipients. We report a case series of extrarenal pseudoaneurysm after kidney transplant with different clinical presentations and management strategies. Given the rarity of EPSA, literature describing this complication is limited to single case reports or small retrospective case series. We also provide an up-to-date review of 76 articles on mycotic, bacterial, and idiopathic EPSAs. Allograft removal is considered standard treatment, but new endovascular alternatives may allow allograft salvage. EPSA should be managed with a multidisciplinary approach. Surveillance with renal ultrasound is recommended in patients considered high risk.
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Petersen KE, Hunt TM, McMenomy BP, Prieto M. Sonographic Assessment of Renal Transplant Anastomotic Pseudoaneurysm: A Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal transplant anastomotic pseudoaneurysms (RTAPs) are a rare vascular postoperative complication. The etiology of these pseudoaneurysms is attributed to infection or surgical vessel damage. RTAPs can lead to allograft dysfunction, allograft loss, or patient mortality due to rupture or sepsis. Because of these serious complications, expedient diagnosis is imperative for initiating surgical intervention and medical management. Sonography is a useful imaging modality for diagnosing and characterizing RTAPs. The sonographic findings, although not often described in detail in the literature, are definitive and unique. This case report describes the sonographic findings of a patient 22 days post renal autotransplant, who presented with excruciating abdominal pain. Sonographic examination identified multiple classic pseudoaneurysm findings and demonstrated intrarenal and extrarenal vascular abnormalities.
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Affiliation(s)
| | | | | | - Mikel Prieto
- Department of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
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Asif S, Bennett J, Pauly RR. A Rare Case of an Infectious Pseudoaneurysm due to Aspergillus flavus in the Setting of Renal Transplant. Cureus 2019; 11:e4208. [PMID: 31114727 PMCID: PMC6505728 DOI: 10.7759/cureus.4208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Renal transplant as a treatment option for end-stage renal disease (ESRD) is becoming increasingly prevalent. As with any other surgical intervention, complications may occur, including vascular ones. Pseudoaneurysms are particularly rare, with mycotic aneurysms reported in less than 1% of patients after renal transplant. Here, we present a case of an infected pseudoaneurysm involving the renal artery anastomosis, resulting in the explantation of the transplanted kidney. A 77-year-old man underwent deceased donor renal transplant for ESRD in the setting of diabetes and hypertension. He presented with acute kidney injury; a renal biopsy revealed mild active cellular rejection, treated with high-dose steroids. As renal function continued to deteriorate, a repeat renal biopsy was performed. During ultrasound-guided biopsy of the transplanted kidney, a possible aneurysm proximal to the anastomosis of the renal artery to the right external iliac artery was seen. A pelvic arteriogram showed a large 3 cm x 3.4 cm x 4 cm pseudoaneurysm arising directly off the right external iliac artery with the renal transplant artery filling from the distal side of this aneurysm. The patient was taken to the operation room for a re-exploration of his transplanted kidney and revision of the arterial anastomosis. Intraoperatively, necrotic tissue and purulence within the pseudo-aneurysm were noted with failure to salvage blood supply to the transplanted kidney; both the infected pseudo-aneurysm and renal transplant were resected. A portion of the aneurysm was sent to microbiology for culture; fungal cultures grew Aspergillus flavus. He was treated with isavuconazonium and improved clinically, though he subsequently expired following a sudden cardiac arrest. Given its rarity, most medical professionals will be unfamiliar with this unusual complication in renal transplant patients. Our case highlights the importance of pursuing imaging modalities to help identify vascular complications and discusses how to proceed after diagnosis is made. The importance of knowing this process is paramount in improving future patient outcomes.
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Affiliation(s)
- Samia Asif
- Internal Medicine, University of Missouri, Kansas City, USA
| | - Joseph Bennett
- Internal Medicine, University of Missouri, Kansas City, USA
| | - Rebecca R Pauly
- Internal Medicine, Virginia Tech-Carilion School of Medicine, Roanoke, USA
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