Infective Artery Rupture of Renal Allografts: A Single-Center Retrospective Study in China

Abstract

Objective

This study investigated the composition of pathogenic microorganisms, clinical features, and therapeutic strategies of infective artery rupture of renal allografts in recipients receiving deceased donor (DD) kidneys.

Methods

We retrospectively studied the clinical data of the DD kidney transplant recipients with donor-associated infection at Tongji Hospital, Wuhan, China from January 1, 2015 to December 31, 2018, related recipients and corresponding donors. We collected the entire results of pathogenic microorganisms cultured from these related ruptured kidneys and then analyzed their distribution and differences.

Results

A total of 1440 kidney transplants from DD were performed in our center. The total incidence of infective artery rupture in kidney transplants was about 0.76% (11/1440), and the annual incidence ranged from 0.25% to 1.03%. The microbial culture results revealed that 11 recipients suffered from infective artery rupture and 3 recipients who accepted the kidney from same donor had the donor-associated pathogens, including 9 fungal strains (28.1%) and 23 bacterial strains (71.9%). There were 4 recipients infected with multi-drug-resistant Staphylococcus and Klebsiella pneumoniae from the above 11 recipients, of which, 10 recipients underwent graft loss, and one died of septic shock. The microbial cultures of the remaining 3 recipients who received appropriate anti-infective regimens turned negative eventually, and the patients were discharged successfully without significant complications.

Conclusion

Renal recipients with infections derived from DDs were at high risk of artery rupture, graft loss, or even death. Appropriate anti-infective treatment is essential to reduce the incidence of artery rupture and mortality.

Keywords

kidney transplantation / deceased donor / renal artery rupture / infection

References

[1] OktarT, KoçakT, TefikT, et al.. An updated analysis of the surgical and urological complications of 789 living-related donor kidney transplantations: Experience of a single center. Ulus Travma Acil Cerrahi Derg, 2020, 26(2): 197-202

[2] AsztalosL, OlvasztóS, FedorR, et al.. Renal artery aneurysm at the anastomosis after kidney transplantation. Transplant Proc, 2006, 38(9): 2915-2918

[3] CalviñoJ, RomeroR, PintosE, et al.. Renal artery rupture secondary to pretransplantation Candida contamination of the graft in two different recipients. Am J Kidney Dis, 1999, 33(1): E3

[4] KaabakM, BabenkoN, ZokoevA, et al.. Successful repair of kidney graft artery rupture using external stenting. Transplantation, 2013, 95(7): e48-49

[5] PappasPG, AlexanderBD, AndesDR, et al.. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis, 2010, 50(8): 1101-1111

[6] YeQF, ZhouW, WanQQ. Donor-derived infections among Chinese donation after cardiac death liver recipients. World J Gastroenterol, 2017, 23(31): 5809-5816

[7] LewisJD, SifriCD. Multidrug-Resistant Bacterial Donor-Derived Infections in Solid Organ Transplantation. Curr Infect Dis Rep, 2016, 18(6): 18

[8] VaccarisiS, BonaiutoE, SpadaforaN, et al.. Complications and graft survival in kidney transplants with vascular variants: our experience and literature review. Transplant Proc, 2013, 45(7): 2663-2665

[9] WangY, LeiH, ZhangY, et al.. Epidemiology of carbapenem-resistant Klebsiella pneumoniae bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis. Antimicrob Resist Infect Control, 2018, 7: 66

[10] LaouadI, BuchlerM, NoelC, et al.. Renal artery aneurysm secondary to Candida albicans in four kidney allograft recipients. Transplant Proc, 2005, 37(6): 2834-2836

[11] PolatKY, AydinliB, KelesM, et al.. Spontaneous mycotic external iliac artery aneurysm rupture after perforated acute appendicitis in a renal allograft recipient. Exp Clin Transplant, 2011, 9(3): 211-213

[12] BarlasA, MorisD, BokosJ, et al.. A forgotten vascular technique in renal transplantation. Vasc Endovascular Surg, 2014, 48(3): 281-282

[13] AdaniGL, BaccaraniU. The use of iliac Y-graft for arterial revascularization in simultaneous double-kidney transplantation. Transplantation, 2012, 93(12): e46-48

[14] EzzatzadeganS, ChenS, ChapmanJR. Invasive fungal infections after renal transplantation. Int J Organ Transplant Med, 2012, 3(1): 18-25

[15] GuimarãesLF, HalpernM, de LemosAS, et al.. Invasive Fungal Disease in Renal Transplant Recipients at a Brazilian Center: Local Epidemiology Matters. Transplant Proc, 2016, 48(7): 2306-2309

[16] MatignonM, BotterelF, AudardV, et al.. Outcome of renal transplantation in eight patients with Candida sp. contamination of preservation fluid. Am J Transplant, 2008, 8(3): 697-700

[17] ZhanHX, LvY, ZhangY, et al.. Hepatic and renal artery rupture due to Aspergillus and Mucor mixed infection after combined liver and kidney transplantation: a case report. Transplant Proc, 2008, 40(5): 1771-1773

[18] GavaldàJ, MeijeY, FortúnJ, et al.. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect, 2014, 20(Suppl 7): 27-48

[19] SchmiedelY, ZimmerliS. Common invasive fungal diseases: an overview of invasive candidiasis, aspergillosis, cryptococcosis, and Pneumocystis pneumonia. Swiss Med Wkly, 2016, 146: w14281

[20] WangR, WuJ, WangY, et al.. Aspergillus infection limited to the anastomosed artery following renal transplantation: a report of 4 cases. Transpl Infect Dis, 2009, 11(4): 363-366

[21] ZhuX, LiuH, WangW, et al.. Two cases of transplant renal artery thrombosis and spontaneous rupture caused by mucormycosis. Transpl Infect Dis, 2015, 17(3): 442-448

[22] HusainS, TollemarJ, DominguezEA, et al.. Changes in the spectrum and risk factors for invasive candidiasis in liver transplant recipients: prospective, multicenter, case-controlled study. Transplantation, 2003, 75(12): 2023-2029

[23] MaiH, ChampionL, OualiN, et al.. Candida albicans arteritis transmitted by conservative liquid after renal transplantation: a report of four cases and review of the literature. Transplantation, 2006, 82(9): 1163-1167

[24] GomezCA, SinghN. Donor-derived filamentous fungal infections in solid organ transplant recipients. Curr Opin Infect Dis, 2013, 26(4): 309-316

[25] TangM, XuX, ShenB, et al.. Fifty-one cases of fungal arteritis after kidney transplantation: A case report and review of the literature. Transpl Infect Dis, 2017, 19(6): e12781

[26] UsmanR, JamilM, SafdarA, et al.. Successful Repair of a Pseudoaneurysm of Renal Allograft Artery. J Coll Physicians Surg Pak, 2015, 25(Suppl 2): S142-144

[27] LiuG, WangX, WuJ, et al.. Successful repair of kidney graft artery rupture secondary to infection using a preprocessed homologous “Y”-shaped iliac artery. Clin Transplant, 2019, 33(4): e13493

[28] Caño-VelascoJ, Polanco-PujolL, González-GarcíaJ, et al.. Renal artery infectious (mycotic) pseudoaneurysms in renal transplantation recipients. Actas Urol Esp (Engl Ed), 2021, 45(5): 335-344

[29] CheHJ, SongFB, LiXY, et al.. Retrospective evaluation of the endovascular repair of the anastomotic pseudoaneurysm of the transplanted renal artery using the snorkel technique. Vascular, 2020, 28(4): 475-480