A case of anastomotic leak due to Candida albicans infection in a 64-year-old female renal transplant patient treated with an emergency suprapubic iliofemoral bypass graft

Abstract

Vascular complications are a rare but important risk factor for failure and loss of kidney graft, increasing the mortality of renal graft recipients.We present the case of massive haemorrhage due to the rupture of the arterial anastomosis caused by Candida albicans infection in a 64-year old female kidney graft recipient managed with suprapubic iliofemoral bypass during emergency life-saving graft nephrectomy performed in our unit. The postoperative period was complicated by femoral vein thrombosis and intraabdominal fluid collection. After 33 days, with a well-functioning iliofemoral bypass, the patient was discharged to the nephrology unit. At the 12-month follow-up, the patient is functioning well, receiving nephrological care and haemodialysis treatment.Routine fungal cultures of graft preservation fluid and radiological follow-up in high-risk patients after transplantation may be helpful in the prevention of fatal complications in the high-risk patient group – especially if digestive tract injury occurred during organ harvesting. Nevertheless, histological examination remains the gold standard for the detection of fungal arteritis. Negative culture samples from the preservation fluid, blood and urine before the transplantation do not exclude the risk of fungal infection. Urgent allograft nephrectomy with resection and reconstruction of changed vessels seems to be the safest approach in ruptured anastomotic pseudoaneurysm, as shown in our case.