Two Cases of Post-Kidney Transplantation Thrombotic Microangiopathy From a Single Donor With Candidemia.

Thrombotic microangiopathy (TMA) secondary to donor-derived infections remains a rare, yet serious source of graft loss and increased patient morbidity and mortality. Among TMA etiologies, donor-derived fungal infections remain particularly challenging to test for pre-operatively and treat post-operatively. We describe 2 cases of post-kidney transplant TMA from a single donor with suspected candidemia. Despite prophylactic treatment for Candida with fluconazole and eculizumab for TMA, 1 of the 2 patients unfortunately succumbed to TMA-related complications. The other patient, who also received fluconazole and eculizumab, had persistent hemolysis and ultimately required a transplant nephrectomy. Following nephrectomy, the patient's symptoms and laboratory values improved and the patient was able to be discharged to inpatient rehab before returning home. Despite appropriate treatment for Candida and TMA, patient outcomes were unfavorable. These 2 cases underscore the difficulties in treating TMA in the setting of organ transplantation and candidemia, pointing to the necessity for more research into improved treatment approaches.