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Boutin CA, Pouch SM, Ison MG. Utility of deceased donor cultures in solid organ transplantation in preventing donor-derived bacterial and fungal infectious diseases transmission. Transpl Infect Dis 2023; 25:e14032. [PMID: 36748658 DOI: 10.1111/tid.14032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by the risk of donor-derived infection (DDI) and the consequence of organ non-utilization and account for potential unintended effects of antimicrobial use in the recipient. In this review, we summarize the literature on bacterial and fungal DDIs, describe the significance of positive cultures by anatomic site, and summarize current guidance on the management of positive cultures from donors or preservation fluids.
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Affiliation(s)
- Catherine-Audrey Boutin
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael G Ison
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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2
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Zhang X, Shan H, Zhang M, Yang H, Gu L, Mi Z, Wang X, Wang Y, Tang Z, Shan H, Zhang X. Donor-Derived Infection's Prevention and Control in Kidney Transplantation. Transplant Proc 2023; 55:22-29. [PMID: 36682943 DOI: 10.1016/j.transproceed.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/07/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The study aimed to summarize the experience of donor selection and recipient therapy in the face of potential donor-derived infections and improve the quality of donor organ utilization, which would help reduce the risk of infection after recipient operation and decrease the risk of loss or even death of recipient kidney transplantation. METHODS In this study, 132 kidneys from 70 donors and their recipients who underwent surgery between July 2017 and January 2021 were studied to perform a retrospective analysis of their etiologic examination results and treatment process. RESULTS In the 70 donors, only 25 had negative etiologic examination results, accounting for 35.71%. Among the 132 recipients, 31.82% had positive culture results, 3 (2.27%) experienced donor-derived infections, and one died. CONCLUSIONS Although infection in the donor before the donation is quite common, the incidence of donor-derived infections is relatively low. The targeted and preventive application of adequate sensitive antibiotics in the whole course of therapy was the cornerstone for treating recipients at potential risk of potential donor-derived infection. The changes in infection indicators in the recipient should be closely monitored, which would guide medication adjustments timely. These measures could, to a great degree, ensure the prognosis of the recipient, in turn reducing the adverse events caused by donor-derived infections.
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Affiliation(s)
- Xin Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China
| | - Hui Shan
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China
| | - Min Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China
| | - Hui Yang
- Department of Pharmaceuticals, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Gu
- Department of Infectious Disease, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zixin Mi
- Department of Organ Procurement Organizations Office, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuezhu Wang
- Department of Organ Procurement Organizations Office, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yaping Wang
- Department of Organ Procurement Organizations Office, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ziren Tang
- Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Shan
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China.
| | - Xiaodong Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Institute of Urology, Capital Medical University, Beijing, China.
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3
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Tan J, Wild A, Reid G, Shantier M. Management of early graft candidiasis in a kidney transplant recipient. BMJ Case Rep 2022; 15:15/11/e250890. [DOI: 10.1136/bcr-2022-250890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Balancing adequate immunosuppression with the risk of infection after renal transplantation remains a challenge. The presence of comorbidities adds to the challenge. Although infrequent, invasive fungal infections result in high morbidity and mortality risk in renal transplant recipients. This can be attributed to the intense immunosuppression in the first 6 months after renal transplantation, minimal symptomatology and the high mortality associated with fungal infections.Due to minimal available evidence, clinical judgement guides management of graft candidiasis. There is a need to develop evidence-based management guidelines for the treatment of fungal infections in renal transplants. Here, we report a case of early-onset candidiasis in a transplanted kidney and present the histological findings, multidisciplinary discussions and treatment given.
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4
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Alghamdi AA, Hussain A, Bosaeed M, Selimovic N, Zaibag MA. Successful heart transplantation from a donor with bacterial and fungal bloodstream infection: Case report of donor optimization strategy. J Card Surg 2022; 37:2440-2442. [PMID: 35535367 DOI: 10.1111/jocs.16609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
Donor optimization is vital to increase donor hearts utilized for transplantation. We report a case of a 34-year-old female with end-stage cardiomyopathy that was admitted to the intensive care unit on inotropic support with progressive decline (INTERMACS-2). She was offered a donor heart from a 14-year male that was found to have Klebsiella pneumoniae bacteremia and candidemia co-infection. The donor was transferred to our hospital and optimized hemodynamically and biochemically. Targeted antimicrobial and antifungal therapy based on the susceptibility testing was established in the donor till blood cultures were negative. The recipient received similar prophylactic therapy for 2-week course starting 24-h before transplantation. The patient was transplanted with no clinical consequences. She was discharged home in 4 weeks post-transplantation. Her 3-month follow-up was completely uneventful.
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Affiliation(s)
- Abdullah A Alghamdi
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Arif Hussain
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nedim Selimovic
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Muayed A Zaibag
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Guo YL, Lu X, Zhu L, Du DF, Liu B, Chen ZHK, Chen S, Zhang WJ, Chen ZS, Chang S. Infective Artery Rupture of Renal Allografts: A Single-Center Retrospective Study in China. Curr Med Sci 2022; 42:847-855. [PMID: 35511412 DOI: 10.1007/s11596-022-2557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Yu-Liang Guo
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Xia Lu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Lan Zhu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Dun-Feng Du
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Bin Liu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Zhong-Hua Klaus Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Song Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Wei-Jie Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Zhi-Shui Chen
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China.,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China
| | - Sheng Chang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Key Laboratory of Organ Transplantation, Ministry of Education, Wuhan, 430030, China. .,NHC Key Laboratory of Organ Transplantation, Wuhan, 430030, China. .,Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, 430030, China.
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Renal artery infectious (mycotic) pseudoaneurysms in renal transplantation recipients. Actas Urol Esp 2021; 45:335-344. [PMID: 34088432 DOI: 10.1016/j.acuroe.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Infection of the artery at or around the anastomotic site is an ominous complication commonly presenting as a leak and/or local dissolution of the arterial wall. MATERIAL AND METHODS Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management. FINDINGS Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent (<1% of cases), mostly related with infection (contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery. CONCLUSIONS Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.
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7
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Candida Contamination in Kidney and Liver Organ Preservation Solution: Does It Matter? J Clin Med 2021; 10:jcm10092022. [PMID: 34065096 PMCID: PMC8125956 DOI: 10.3390/jcm10092022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Fungal infections remain a major challenge affecting outcomes after kidney (KT) and liver transplantation (LT). METHODS In this retrospective single center study, the incidence of Candida contamination in renal and hepatic graft preservation solution (PS) was evaluated. In addition, Candida associated infections in recipients and related complications were analyzed. RESULTS Overall, the PS of 1248 hepatic and 1273 renal grafts were evaluated. The incidence of fungal contamination in the PS of hepatic and renal grafts was 1.2% and 0.86%, respectively. Additionally, the hepatic PS of one patient who underwent a combined liver-kidney transplant had Candida contamination. Candida albicans was the most common organism (70.4%) and 65.4% of the patients received antifungal treatment. Candida-associated complications in the recipients was 19%. Complications in LT patients included Candida peritonitis and Candida sepsis. Two KT recipients with contaminated PS developed a mycotic aneurysm at the anastomotic site resulting in severe bleeding. The 1-year mortality in patients with PS contamination for LT and KT recipients was 33% and 18%, respectively. Although the incidence of fungal contamination of PS was low, contaminated PS was associated with a high mortality. CONCLUSION The results of the study suggest that PS should be evaluated for fungal growth.
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8
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Al Midani A, Hookham L, Banga N, Jones G, Collier S. The Value of Perfusion Fluid Culture Analysis in Deceased Donor Renal Transplants: A 10-Year Single-Center Experience. Transplant Proc 2021; 53:1808-1812. [PMID: 33962779 DOI: 10.1016/j.transproceed.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/06/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Microbiological analysis of kidney perfusion/transport solution is not routinely performed in all transplant centers. This paper gives a 10-year descriptive single-center experience of the routine culture of perfusion fluid in deceased donor renal transplant recipients as well as the prophylactic treatment of certain organisms if identified. Data were collected retrospectively on all deceased donor transplants performed between 2009 and 2018. Organisms detected were classified as either pathologic, of uncertain pathogenicity, or contaminants. Treatment was guided by the microbiology team. A total of 661 specimens were analyzed. Organisms were cultured in 168 of 661 (25.4%) of these samples. The most frequent organisms identified were skin and oral flora (n = 95, 42%). The majority of organisms identified (131 of 226, 58%) necessitated prophylactic treatment on the advice of our microbiology department. On 7 (4.2%) occasions, the perfusion fluid cultures grew organisms not covered by the routine antimicrobial prophylaxis, and on 15 occasions Candida albicans was isolated. Candida isolates were treated preemptively with 1 month of antifungal treatment. There were no infective sequelae in this group.
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Affiliation(s)
- Ammar Al Midani
- Royal Free London NHS Foundation Trust, Kidney and Urology, London, UK
| | - Lauren Hookham
- Royal Free London NHS Foundation Trust, Kidney and Urology, London, UK.
| | - Neal Banga
- Royal Free London NHS Foundation Trust, Kidney and Urology, London, UK
| | - Gareth Jones
- Royal Free London NHS Foundation Trust, Kidney and Urology, London, UK
| | - Sophie Collier
- Royal Free London NHS Foundation Trust, Microbiology, London, UK
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Abstract
INTRODUCTION Infection of the artery at or around the anastomotic site is an ominous complication commonly presenting as a leak and/or local dissolution of the arterial wall. MATERIAL AND METHODS Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management. FINDINGS Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent(<1% of cases),mostly related with infection(contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery. CONCLUSIONS Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.
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10
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Flateau C, Aït-Ammar N, Angebault C, Salomon L, Matignon M, Lepeule R, Melica G, Grimbert P, Lelièvre JD, Gallien S, Botterel F. Risk factors for intra-abdominal fungal infection after simultaneous pancreas-kidney transplantation: A single-center retrospective experience. Transpl Infect Dis 2020; 23:e13486. [PMID: 33047447 DOI: 10.1111/tid.13486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/17/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Data on the risk factors and outcome of intra-abdominal fungal infections (IAFI) following simultaneous pancreas-kidney transplantation (PKT) are scarce. MATERIALS/METHODS A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post-transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed. RESULTS Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n = 4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P = .007) and fungal contamination of PF (3/7 vs 0/8, P = .008). Among patients with IAFI, all required an early surgical revision post-transplantation [1-18 days] and six had early or delayed pancreatic graft removal. One patient died in the first post-transplant year. CONCLUSION IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.
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Affiliation(s)
- Clara Flateau
- Service de maladies infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France.,Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France
| | - Nawel Aït-Ammar
- Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Cécile Angebault
- Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Laurent Salomon
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'urologie, APHP, CHU Henri Mondor, Créteil, France
| | - Marie Matignon
- Service de néphrologie, APHP, CHU Henri Mondor, Créteil, France
| | - Raphaël Lepeule
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Unité Transversale du traitement des infections, Département Prévention, Diagnostic, DMU Biologie-Pathologie, APHP, CHU Henri Mondor, Créteil, France
| | - Giovanna Melica
- Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | | | - Jean-Daniel Lelièvre
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | - Sébastien Gallien
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | - Françoise Botterel
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
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11
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O' Connell K, Kennedy C, Skally M, Foley M, Alex S, Magee C, Davis NF, Humphreys H, Burns K. Surveillance of common infections in the early period after renal transplantation in a national center: 2014-2017. Transpl Infect Dis 2020; 22:e13261. [PMID: 32037682 DOI: 10.1111/tid.13261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/09/2020] [Accepted: 02/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infection prevention and timely and effective treatment are among the major aims of care in kidney transplant recipients. Pre-transplant vaccination and pre-transplant viral screening have been extensively studied and are now considered standard practice. Early post-operative infection surveillance is mandatory in other vulnerable cohorts, but has not been extensively studied in this population. We hypothesized that surveillance of the most common bacterial infection types in the post-transplant setting would be beneficial and identify key areas for improvement. METHODS All adult kidney transplant recipients whose surgeries were performed in the Irish national kidney transplant unit over a 1-year period had prospective early post-transplant (first 30 days) infection surveillance in 2014 for surgical site infection, urinary tract infection, and secondary bloodstream infections (Group T0). Several key changes were implemented following scrutiny of infection patterns and clinical practice. Subsequently, infection surveillance was undertaken for 2016 and 2017 (Group T1) to assess the impact of these changes. RESULTS Between 2014 and 2017, the number of kidney transplants increased by 32%. The following aspects of clinical practice were the focus of change following analysis of Group T0 data: timing of surgical antimicrobial prophylaxis (SAP) administration, choice of SAP antimicrobial agent, and routine microbiological testing in the peri-operative period. Following implementation of these changes, the timing of SAP administration was greatly improved (45%-100% of cases appropriately timed). The infection rate decreased from 8.9% to 7.4% in 2016, with a further decrease to 4% in 2017 (OR 0.42 (95% CI: 0.16-1.10); P = .08). Compliance with pre-operative microbiological screening improved in Group T1. CONCLUSIONS Simple clinical practice changes, implemented upon analysis of common bacterial infection surveillance data in the first 30 days after kidney transplantation resulted in more effective SAP administration and improved compliance with routine microbiological testing in the peri-operative period. These interventions have potentially contributed to reduced early post-operative infection rates, despite increased transplant activity in the unit. Infection surveillance is an important and under-utilized way of reducing infections in this vulnerable patient cohort.
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Affiliation(s)
- Karina O' Connell
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Claire Kennedy
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Mairead Skally
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Margaret Foley
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Somy Alex
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
| | - Colm Magee
- Department of Nephrology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Karen Burns
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland.,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Health Protection Surveillance Centre, Dublin, Ireland
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12
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Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation: do we pay higher risk of severe infection after transplantation?: a case report. BMC Infect Dis 2020; 20:115. [PMID: 32041547 PMCID: PMC7011237 DOI: 10.1186/s12879-020-4835-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/28/2020] [Indexed: 01/16/2023] Open
Abstract
Background Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation are becoming popular in Italy, with the purpose of reducing the risk of primary non function and delayed graft function due to the prolonged warm ischemia time. Potential complications related to these procedures are currently under investigation and are continuously emerging with the increasing experience. Post-operative infections - in particular graft arteritis - are a rare complication but determine high risk of mortality and of graft loss. The acute onset of the arterial complications makes it very difficult to find an effective treatment, and early diagnosis is crucial for saving both patient and graft. Prevention of such infections in this particular setting are advisable. Case presentation We present a patient with an acute arterial rupture after transplantation of a DCD graft treated in-vivo hypothermic oxygenated perfusion. The cause was a severe arteritis of the renal artery caused by Candida krusei and Pseudomonas aeruginosa. We discussed our treatment and we compared it to the other reported series. Conclusion Fungal infections in DCD transplant may be treacherous and strategies to prevent them should be advocated.
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Anglicheau D, Tinel C, Canaud G, Loupy A, Zuber J, Delville M, Rabaté C, Scemla A, Snanoudj R, Sberro-Soussan R, Mamzer-Bruneel MF, Bererhi L, Martinez F, Timsit MO, Rabant M, Correas JM, Bienaimé F, Duong JP, Hélénon O, Prié D, Méjean A, Legendre C. [Renal transplantation: Procedure and early follow-up]. Nephrol Ther 2019; 15:469-484. [PMID: 31640943 DOI: 10.1016/j.nephro.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
More than fifty years after the success of the two first renal transplantations in Boston and in Necker hospital in Paris, renal transplantation became the treatment of choice of end stage renal failure, because it improves not only the quality of life of the patients but also their long-term survival. In France, more than 3,700 kidney transplantations are performed every year and more than 40,000 patients are living with a functioning kidney allograft. This treatment of end stage renal disease requires a fine-tuned pre-transplant evaluation and a multidisciplinary post-transplant care in order to prevent, to detect and to treat comorbidities and complications of immunosuppression. The ambition of this manuscript is not to describe in an exhaustive way all the aspects of renal transplantation but starting from the experience of a team, recently published data, and national and international guidelines, to try to provide a synthetic and chronological view of the early post-transplant monitoring.
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Affiliation(s)
- Dany Anglicheau
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
| | - Claire Tinel
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Guillaume Canaud
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Alexandre Loupy
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Julien Zuber
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Marianne Delville
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Clémentine Rabaté
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Anne Scemla
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Renaud Snanoudj
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Rébecca Sberro-Soussan
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | | | - Lynda Bererhi
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Frank Martinez
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Marc-Olivier Timsit
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Marion Rabant
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Jean-Michel Correas
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de radiologie adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Frank Bienaimé
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'exploration fonctionnelle, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Jean-Paul Duong
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Olivier Hélénon
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de radiologie adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Dominique Prié
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'exploration fonctionnelle, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Arnaud Méjean
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Christophe Legendre
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
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Cabrera P, Centeno A, Revollo J, Camargo JF. The role of preemptive antimicrobial therapy in kidney recipients of urine-only positive donor cultures. Transpl Infect Dis 2019; 21:e13150. [PMID: 31349382 DOI: 10.1111/tid.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/14/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of preemptive antimicrobial therapy for recipients of donors with microbial growth on pre-transplant urine cultures remains poorly studied. METHODS Single-center retrospective study of kidney transplant recipients of allografts from deceased donors with urine-only (ie, in absence of donor bacteremia) positive cultures (September 2011 to August 2015). Transplant outcomes, including donor-derived infections (DDI) within the first three months post transplant, were analyzed. RESULTS Of the 970 kidney transplants performed during the study period, urine cultures were obtained from all donors, and of these, 27 (2.8%) yielded growth. Twenty-nine (73%) recipients were treated preemptively after transplantation. All of the recipients of donors with urine cultures positive for Enterococcus, Pseudomonas, or Candida spp. received therapy whereas only one of seven recipients with urine cultures positive for Escherichia coli was treated (P < .0001). All E coli isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), which was given to all patients for Pneumocystis pneumonia (PCP) prophylaxis. Infection within 3 months was evident in 16 (40%) patients: 10 out of 29 (35%) in the preemptive group and 6 out of 11 (55%) in the not-treatment group (P = .29). Evidence of DDI occurred in two recipients, one in each group. There were no differences in one-year graft and patient survival between groups. CONCLUSION Preemptive antibiotic therapy did not seem to impact transmission events and transplant outcomes in this small cohort. Low transmission rates might have been influenced by administration of PCP prophylaxis and universal preemptive therapy for positive donor urine cultures with virulent organisms. Larger studies are needed.
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Affiliation(s)
- Pierina Cabrera
- Department of Pharmacy Services, Jackson Memorial Hospital, Miami, FL, USA
| | - Alexandra Centeno
- Department of Pharmacy Services, Jackson Memorial Hospital, Miami, FL, USA
| | - Jane Revollo
- Department of Pharmacy Services, Jackson Memorial Hospital, Miami, FL, USA
| | - Jose F Camargo
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
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15
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Corbel A, Ladrière M, Le Berre N, Durin L, Rousseau H, Frimat L, Thilly N, Pulcini C. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study. Clin Microbiol Infect 2019; 26:475-484. [PMID: 31382016 DOI: 10.1016/j.cmi.2019.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Kidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures. METHODS We performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data. RESULTS Of 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1-9.1), multiorgan procurement (OR 1.4, 95% CI 1.1-1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3-4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3-0.5 and OR 0.6, 95% CI 0.5-0.7, respectively). CONCLUSION In conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause.
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Affiliation(s)
- A Corbel
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France.
| | - M Ladrière
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France
| | - N Le Berre
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France
| | - L Durin
- Agence de la Biomédecine, Saint Denis La Plaine, France
| | - H Rousseau
- Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France
| | - L Frimat
- Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France
| | - N Thilly
- Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France
| | - C Pulcini
- APEMAC, University of Lorraine, Nancy, France; Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, Nancy, France
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16
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Infections in Heart, Lung, and Heart-Lung Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7121494 DOI: 10.1007/978-1-4939-9034-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source of significant morbidity and mortality. Recognition of infections and its management in this setting require outstanding clinical skills since transplant recipients may not exhibit classic signs or symptoms of disease, and laboratory work has some pitfalls. The prevention, identification, and management of infectious diseases complications in this population are a priority to undertake to improve the medical outcomes of transplantation. Herein, we reviewed the historical aspects, epidemiology, and prophylaxis of infections in heart, lung, and heart-lung transplantation. We also discuss the most prevalent organisms affecting the host and the organ systems involved.
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17
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Emerging Candida species isolated from renal transplant recipients: Species distribution and susceptibility profiles. Microb Pathog 2018; 125:240-245. [PMID: 30240817 DOI: 10.1016/j.micpath.2018.09.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 02/02/2023]
Abstract
Candidiasis is a major challenge among renal transplant recipients (RTRs) worldwide and is associated with high morbidity and mortality rates. Fluconazole is the most commonly used agent for Candida infections. However, frequent relapse and treatment failure are still reported among patients affected with this infection. In the present study, Candida species obtained from RTRs were characterized based on conventional and molecular assays. Furthermore, the antifungal susceptibility profiles of these species were determined. This study was conducted on a total of 126 RTRs within 2012-2016. The patients were categorized according to the referenced diagnostic criteria. The identification of Candida species was accomplished based on conventional examination, assimilation profile test, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, and caspofungin were determined based on the guidelines of Clinical and Laboratory Standards Institute. The patients with Candida infection were diagnosed with urinary tract candidiasis (n = 17), peritonitis (n = 8), intra-abdominal candidiasis (n = 6), candidemia (n = 4), hepatosplenic candidiasis (n = 3), and Candida pneumonia (n = 3). A total of 41 Candida isolates, including C. albicans (n = 18), C. famata (n = 8), C. kefyr (n = 4), C. tropicalis (n = 4), C. parapsilosis (n = 3), C. glabrata (n = 2), and C. lusitaniae (n = 2), were isolated from 32.5% (41/126) renal transplant recipients. Fluconazole-resistance was observed in seven isolates, entailing C. albicans (n = 6) and C. tropicalis (n = 1). Fluconazole MIC for C. lusitaniae isolates was above the epidemiologic cut-off value (4-16 μg/ml). Furthermore, MIC range values of fluconazole against C. famata and C. kefyr were obtained as 4-32 μg/ml and 4-8 μg/ml, respectively. Posaconazole exhibited potent activity against Candida isolates, followed by caspofungin. The identification of Candida species, together with susceptibility testing, provides important data about the geographic trends of the fluconazole-resistance profiles of Candida species. It is necessary to maintain a consistent method for the implementation of early diagnosis and adoption of treatment regimen.
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18
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Teh YE, Ang MLT, La MV, Gunalan V, Tan CK, Tan AL, Lin RTP, Tan TT, Jeyaraj PR, Cumaraswamy S, Tan BH. Donor-Derived Candida dubliniensis Resulting in Perigraft Abscesses in a Liver Transplant Recipient Proven by Whole Genome Sequencing: A Case Report. Transplant Proc 2018; 50:915-919. [PMID: 29661462 DOI: 10.1016/j.transproceed.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The transmission of fungi via transplant, although well-known, has not often been molecularly proven. We describe a case of donor-derived candidiasis verified by whole genome sequencing. CASE DESCRIPTION The multiorgan donor was a 42-year-old woman with subdural hemorrhage. Procurement of the thoracic organs was performed followed by the abdominal organs. Tissue from the left bronchus grew Candida dubliniensis. The liver recipient was a 63-year-old woman with cryptogenic liver cirrhosis. She was noted to have worsening leukocytosis on postoperative day (POD) 9. Computed tomography of the abdomen and pelvis showed multiple rim-enhancing collections around the graft. Percutaneous drainage was performed. Fluid cultures grew C dubliniensis. C dubliniensis isolated from the donor's left bronchus and the liver recipient's abscesses were verified to be related by whole genome sequencing. We postulate that C dubliniensis colonizing the donor's transected trachea could have contaminated the inferior vena cava when the former was left open after explant of the donor's lungs. A portion of the donor's contaminated inferior vena cava was transplanted along with the liver graft, resulting in the infected collections in the recipient. CONCLUSIONS Our case report highlights the importance of maintaining a sterile field during organ procurement, especially in a multiorgan donor whose organs are explanted in succession.
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Affiliation(s)
- Y E Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - M L T Ang
- National Public Health Laboratory, Ministry of Health, Singapore
| | - M V La
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - V Gunalan
- Bioinformatics Institute, Agency for Science, Technology and Research, Singapore
| | - C K Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - A L Tan
- Department of Microbiology, Singapore General Hospital, Singapore
| | - R T P Lin
- National Public Health Laboratory, Ministry of Health, Singapore; Department of Laboratory Medicine, National University Hospital, Singapore
| | - T T Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - P R Jeyaraj
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - S Cumaraswamy
- Heart and Lung Transplant Unit, Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - B H Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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19
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Colonization of preservation solution in kidney transplantation: Clinical impact and risk of secondary acute graft pyelonephritis. Prog Urol 2018; 28:322-328. [PMID: 29395835 DOI: 10.1016/j.purol.2017.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 11/27/2017] [Accepted: 12/31/2017] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Bacterial colonization of preservative solutions (PS) remains poorly described in renal transplantation. We investigated the bacterial colonization of the PS and its influence on graft pyelonephritis within one year from the renal transplantation. PATIENTS AND METHODS We cultured 2 samples of PS from 424 patients who underwent a renal transplantation. The follow-up period was one year. An acute graft pyelonephritis was defined as a positive bacteriological urine analysis, with temperature higher than 38.5°C or graft pain. RESULTS In total, 424 samples of PS were tested and 195 were positive for colonization (46%). Forty-five patients developed an acute graft pyelonephritis during the follow-up period (10.6%), of which, 21 (46.7%) showed a colonization of their PS. Twenty-four had no colonization (53.3%). This difference was not significant (P=0.697). DISCUSSION Our data suggest that the bacterial colonization of PS samples does not seem to increase the risk of acute graft pyelonephritis in renal transplant recipients. LEVEL OF EVIDENCE -3.
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20
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Ministro A, Ferreira T, Batista L, Santana A, Alves N, Guerra J, Fernandes E Fernandes J. Mycotic Pseudoaneurysm After Kidney Transplantation: Two Case Reports. Transplant Proc 2018; 49:906-912. [PMID: 28457423 DOI: 10.1016/j.transproceed.2017.01.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vascular complications after kidney transplantation may cause allograft loss. Here, we describe 2 patients with extrarenal mycotic pseudoaneurysm after kidney transplantation. PATIENTS Patient 1 was a 54-year-old man who developed pseudoaneurysm 60 days after transplantation, and patient 2 was a 48-year-old woman who was diagnosed with a pseudoaneurysm 5 months after transplantation. RESULTS Patient 1 had a deceased-donor kidney transplant with end-to-side external iliac arterial anastomosis that was reconstructed 8 days after transplantation owing to rupture and major bleeding. At 60 days after transplantation, he had high serum creatinine level and Doppler ultrasonography showed a pseudoaneurysm of the arterial graft anastomosis and postanastomotic renal artery stenosis. Treatment included surgical excision of the pseudoaneurysm, vascular reconstruction, and fluconazole, with mycologic culture of the resected pseudoaneurysm showing Candida albicans. Patient 2 developed nondisabling intermittent claudication at 5 months after kidney transplantation, with a pseudoaneurysm subsequently observed on Doppler ultrasonography and computerized tomographic angiography. Treatment included renal artery thrombectomy and common iliac bypass to the hilar donor renal artery with inverted ipsilateral long saphenous vein. Operative samples showed C albicans, and she was treated with fluconazole. Both patients had satisfactory outcomes, and both kidney allografts were preserved. CONCLUSIONS Extrarenal mycotic pseudoaneurysms after kidney transplantation require a high index of suspicion for early diagnosis, and preservation of the kidney graft may be achieved with the use of surgical treatment and antifungal therapy.
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Affiliation(s)
- A Ministro
- Kidney Transplant Unit, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal; Vascular Surgery Department, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal.
| | - T Ferreira
- Vascular Surgery Department, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal
| | - L Batista
- Kidney Transplant Unit, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal
| | - A Santana
- Kidney Transplant Unit, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal
| | - N Alves
- Kidney Transplant Unit, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal
| | - J Guerra
- Kidney Transplant Unit, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal
| | - J Fernandes E Fernandes
- Vascular Surgery Department, Hospital de Santa Maria, North Lisbon Hospital Center, Lisbon Academic Medical Center, Lisbon, Portugal
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21
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Tang M, Xu X, Shen B, Zhang J, Li P, Pan Q, Mei M, Xie P, Liu H. Fifty-one cases of fungal arteritis after kidney transplantation: A case report and review of the literature. Transpl Infect Dis 2017; 19. [PMID: 28940730 DOI: 10.1111/tid.12781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 04/02/2017] [Accepted: 06/14/2017] [Indexed: 12/27/2022]
Abstract
Fungal arteritis affecting graft arteries is a rare but life-threatening complication in kidney transplantation (KT). Here, we report the case of a patient with Aspergillus arteritis who experienced renal artery rupture 8 days after KT. We also reviewed 50 other reported cases of fungal arteritis after KT. We found that fungal contamination can occur during kidney graft harvest, preservation, and/or transplantation. Typically, early diagnosis, timely antifungal treatment, and emergency surgery seem crucial for avoiding life-threatening vascular complications.
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Affiliation(s)
- Maozhi Tang
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaosong Xu
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bingbing Shen
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jun Zhang
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Peng Li
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qianguang Pan
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Mei Mei
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pan Xie
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hong Liu
- Department of Nephrology, Southwest Hospital, Third Military Medical University, Chongqing, China
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22
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El-Bandar N, Kroy DC, Fuller TF, Kramer J, Liefeldt L, Budde K, Blobel C, Miller K, Friedersdorff F. Development of Graft-Site Candidiasis in 3 Solid Organ Transplant Recipients from the Same Donor. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:777-781. [PMID: 28694422 PMCID: PMC5518847 DOI: 10.12659/ajcr.904119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Case series Patient: Female, 61 • Female, 33 • Female, 58 Final Diagnosis: Candida arteritis Symptoms: Severe bleeding Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Nasrin El-Bandar
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
| | - Daniela C Kroy
- Department of Medicine III, RWTH University Hospital Aachen, Aachen, Germany
| | - Tom Florian Fuller
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
| | - Jürgen Kramer
- Department of Urology, Vivantes Hospital Am Urban, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Conrad Blobel
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany
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Dupont D, Huguenin A, Tisserand E, Reiter V, Morelon E, Badet L, Villena I, Wallon M, Toubas D. Donor Derived Candida stellimalicola in a Clinical Specimen: Preservation Fluid Contamination During Pancreas Procurement. Mycopathologia 2017; 183:573-577. [PMID: 28681316 DOI: 10.1007/s11046-017-0171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Abstract
We report here a case of possible donor-derived Candida stellimalicola infection after pancreas transplantation. Candida stellimalicola, an environmental non-filamentous yeast, was isolated from both the peritoneal fluid of the graft donor and the preservation fluid of the transplanted pancreas. Interestingly, this strain exhibited high minimum inhibitory concentrations to azoles. These results justified the use of echinocandins as therapy instead of fluconazole. This switch permitted a favorable outcome. To our knowledge, this is the first report of C. stellimalicola from clinical samples and therefore the first reported case of a possible human infection. This case report highlights the need for standardized microbiological procedures in solid organ transplant settings. Moreover, it underlines the importance of using molecular identification technique when routine techniques do not allow successful identification of the pathogen. It is of utmost importance to determine sensitivity profile, even in the absence of species-level identification, because resistance to fluconazole is not uncommon, especially in emergent species.
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Affiliation(s)
- Damien Dupont
- Institut des Agents Infectieux, Parasitologie Mycologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France. .,Integrative Physiology of the Brain Arousal Systems, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, 69000, France.
| | - Antoine Huguenin
- Laboratoire de Parasitologie Mycologie, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France
| | - Elodie Tisserand
- Pediatric Intensive Care Unit, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France
| | - Véronique Reiter
- PMO, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
| | - Lionel Badet
- Service d'Urologie et Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
| | - Isabelle Villena
- Laboratoire de Parasitologie Mycologie, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France.,Laboratoire de Parasitologie-Mycologie, EA3800, SFR Cap-Santé, UFR de Médecine, Université de Reims Champagne-Ardenne, Reims, 51100, France
| | - Martine Wallon
- Institut des Agents Infectieux, Parasitologie Mycologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, 69004, France.,Integrative Physiology of the Brain Arousal Systems, Centre de Recherche en Neurosciences de Lyon, INSERM U1028-CNRS UMR 5292, Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, 69000, France
| | - Dominique Toubas
- Laboratoire de Parasitologie Mycologie, CHU de Reims, Université Reims Champagne Ardenne, Hôpital Maison Blanche, Reims, 51092, France.,MéDIAN-Biophotonique et Technologies pour la Santé, CNRS UMR 7369 MEDyC, UFR de Médecine, SFR CAP Santé, Université de Reims Champagne-Ardenne, Reims, 51100, France
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24
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Samanta P, Singh N. Complications of invasive mycoses in organ transplant recipients. Expert Rev Anti Infect Ther 2016; 14:1195-1202. [PMID: 27690694 DOI: 10.1080/14787210.2016.1242412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Opportunistic mycoses remain a significant complication in organ recipients. Areas covered: This review is an evidence-based presentation of current state-of-knowledge and our perspective on recent developments in the field Expert commentary: Invasive fungal infections are associated with reduced allograft and patient survival, increase in healthcare resource utilization, and newly appreciated but largely unrecognized immunologic sequelae, such as immune reconstitution syndrome. Given adverse outcomes associated with established infections, prophylaxis is a widely used strategy for the prevention of these infections. Currently available biomarkers that detect circulating fungal cell wall constituents i.e., galactomannan and 1, 3-β-D-glucan have not proven to be beneficial as screening tools for employing targeted prophylaxis or as diagnostic assays in this patient population. However, subsets of patients at risk for opportunistic fungal infections can be identified based on clinically identifiable characteristics or events. Preventive strategies targeted towards these patients are a rational approach for optimizing outcomes.
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Affiliation(s)
- Palash Samanta
- a Division of Infectious Diseases , University of Pittsburgh , Pittsburgh , PA , USA
| | - Nina Singh
- b Division of Infectious Diseases , University of Pittsburgh and VA Pittsburgh Medical Center , Pittsburgh , PA , USA
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25
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Successful Kidney and Lung Transplantation From a Deceased Donor With Blunt Abdominal Trauma and Intestinal Perforation. Transplant Direct 2016; 2:e55. [PMID: 27500248 DOI: 10.1097/txd.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
Abstract
The number of organ donors is limited by many contraindications for donation and poor quality of potential organ donors. Abdominal infection is a generally accepted contraindication for donation of abdominal organs. We present a 43-year-old man with lethal brain injury, blunt abdominal trauma, and intestinal perforation. After withdrawal of life-sustaining treatment and circulatory arrest, a minilaparotomy confirmed abdominal contamination with intestinal content. After closure of the abdomen, organs were preserved with in situ preservation with an aortic cannula inserted via the femoral artery. Thereafter, the kidneys were procured via bilateral lumbotomy to reduce the risk of direct bacterial contamination; lungs were retrieved following a standard practice. There was no bacterial or fungal growth in the machine preservation fluid of both kidneys. All organs were successfully transplanted, without postoperative infection, and functioned well after 6 months. We hereby show that direct contamination of organs can be avoided with the use of in situ preservation and retroperitoneal procurement. Intestinal perforation is not an absolute contraindication for donation, although the risk of bacterial or fungal transmission has to be evaluated per case.
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26
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Ranghino A, Diena D, Simonato F, Messina M, Burdese M, Piraina V, Fop F, Segoloni GP, Biancone L. Clinical impact of bacterial contamination of perfusion fluid in kidney transplantation. SPRINGERPLUS 2016; 5:7. [PMID: 26759746 PMCID: PMC4700024 DOI: 10.1186/s40064-015-1658-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/22/2015] [Indexed: 01/16/2023]
Abstract
Contamination of perfusion fluid (PF) could lead to serious infections in kidney transplant recipients. Preemptive therapy (PE-T) in case of yeast contamination of PF is mandatory. The usefulness of PE-T in presence of bacteria remains unclear. In this study we evaluated the incidence of PF bacterial contamination and the impact of PE-T on clinical outcome. Microbiological data of 290 PF and clinical data of the corresponding recipients collected in our hospital from January 2010 and December 2012 were analyzed. Recipients with bacterial contaminated PF (101) were divided in 3 groups: group 1 (n = 52) PE-T treated bacteria resistant to perioperative antibiotic prophylaxis (PAP), group 2 (n = 28) bacteria sensitive to PAP, group 3 (n = 21) PE-T-untreated bacteria resistant to PAP. Incidence of positive PF was 34.8 %, 50.4 % staphylococci, 9.9 % C. albicans. No significant differences in the rate of PF-related infections between the three groups were found. In conclusion, although PF contamination is frequent, the incidence of PF-related infections is very low. In addition, in this study PE-T did not help to reduce the rate of PF-related infection suggesting that a resonable reduction in the use of antibiotic terapy could be made. However, waiting for largest and prospective clinical trials to confirm our findings, a closely clinical and microbiologic monitoring of the recipient is highly recommended in case of PF contamination.
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Affiliation(s)
- A Ranghino
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - D Diena
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - F Simonato
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - M Messina
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - M Burdese
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - V Piraina
- Nephrology and Dialysis Unit, University of Magna Grecia, Catanzaro, Italy
| | - F Fop
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - G P Segoloni
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - L Biancone
- Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
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27
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Levesque E, Paugam-Burtz C, Saliba F, Khoy-Ear L, Merle JC, Jung B, Stecken L, Ferrandiere M, Mihaila L, Botterel F. Fungal complications after Candida preservation fluid contamination in liver transplant recipients. Transpl Int 2015; 28:1308-16. [PMID: 26147662 DOI: 10.1111/tri.12633] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/07/2015] [Accepted: 06/18/2015] [Indexed: 12/14/2022]
Abstract
Donor-derived fungal infections can be associated with severe complications in transplant recipients. Donor-derived candidiasis has been described in kidney transplant recipients where contamination of the preservation fluid (PF) was a commonly proposed source. In liver transplantation, these fungal infections have been less explored. The aim of this study was therefore to determine the incidence and clinical relevance of Candida contamination of preservation fluid in the context of liver transplantation. A 5-year (2008-2012) retrospective multicentre study involving six French liver transplantation centers was performed to determine the incidence of Candida PF contamination. Postoperative clinical features, outcomes in recipients, and risk factors for Candida-related complications of liver transplantation were studied. Candida sp. was isolated from 28 of 2107 preservation fluid samples (1.33%). Candida albicans was the most common yeast (n = 18, 64%). Twenty-two recipients (78.5%) received antifungal therapy (echinocandins in 68%) for 7-37 days. Eight patients developed yeast-related complications (28.6%) including hepatic artery aneurysms (n = 6) and Candida peritonitis (n = 2). The 1-year mortality rate among patients after a yeast-related complication was 62.5%. The incidence of Candida PF contamination was low, but was associated with dramatic postoperative complications and high mortality. Close radiological follow-up may enable early recognition of the arterial complications associated with PF contamination by Candida.
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Affiliation(s)
- Eric Levesque
- Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France
| | - Catherine Paugam-Burtz
- Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.,Sorbonne Paris Cité, Univ Paris Diderot, Paris, France.,INSERM U773, CRB3, Paris, France
| | - Faouzi Saliba
- Hepato-Biliairy Centre - Liver ICU, Hôpital Paul Brousse, Villejuif, France
| | - Linda Khoy-Ear
- Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Jean-Claude Merle
- Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France
| | - Boris Jung
- Department of Critical Care Medicine and Anesthesiology, Saint Eloi Teaching Hospital, Montpellier, France.,INSERM U-1046, University Montpellier I, Montpellier II, Montpellier, France
| | - Laurent Stecken
- Intensive Care & Anesthesiology Department, CHU Bordeaux, Bordeaux, France
| | | | - Liliana Mihaila
- Microbiology Unit, G.H. Kremlin-Bicètre, Kremlin-Bicètre, France
| | - Francoise Botterel
- Mycology Unit - Microbiology Department, DHU VIC, EA Dynamyc UPEC-ENVA-GH Henri Mondor, Créteil, France
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28
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Levesque E, Suet G, Merle J, Compagnon P, Amathieu R, Feray C, Botterel F, Foulet F, Azoulay D, Dhonneur G. Candidavascular complication in a liver transplant recipient due to yeast contamination of preservation solution. Transpl Infect Dis 2014; 16:827-9. [DOI: 10.1111/tid.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/13/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023]
Affiliation(s)
- E. Levesque
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - G. Suet
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - J.C. Merle
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - P. Compagnon
- Service de Chirurgie Hépatique et digestive; GH Henri Mondor; Créteil France
| | - R. Amathieu
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
| | - C. Feray
- Service d'Hépatologie; GH Henri Mondor; Créteil France
| | - F. Botterel
- Unité de Parasitologie-Mycologie; Département de Microbiologie; DHU VIC; GH Henri Mondor; Créteil France
| | - F. Foulet
- Unité de Parasitologie-Mycologie; Département de Microbiologie; DHU VIC; GH Henri Mondor; Créteil France
| | - D. Azoulay
- Service de Chirurgie Hépatique et digestive; GH Henri Mondor; Créteil France
| | - G. Dhonneur
- Réanimation digestive; Service d'Anesthésie et des Réanimations Chirurgicales; GH Henri Mondor; Créteil France
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29
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Jr CSK, Koval CE, Duin DV, Morais AGD, Gonzalez BE, Avery RK, Mawhorter SD, Brizendine KD, Cober ED, Miranda C, Shrestha RK, Teixeira L, Mossad SB. Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections. World J Transplant 2014; 4:43-56. [PMID: 25032095 PMCID: PMC4094952 DOI: 10.5500/wjt.v4.i2.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/21/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompting increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.
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30
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Candida species contamination of preservation fluid-outcome of renal transplantation in 6 patients. Transplant Proc 2014; 45:2215-9. [PMID: 23953531 DOI: 10.1016/j.transproceed.2013.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/06/2013] [Accepted: 03/21/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Fungal infections are a rare but important cause of morbidity and mortality in kidney transplantation. Fungal contamination of the kidney preservation fluid may, sometimes, be the cause of these infections. However, the clinical consequences of fungal contamination of this fluid are not completely understood and literature on this topic is controversial. The purpose of this study was to determine the incidence of preservation fluid contamination by fungi and its clinical consequences. METHODS From June 2010 to September 2011, a prospective cohort analysis was conducted at our center, enrolling all patients who received a renal allograft and whose perfusion fluid was analyzed for microbiology sterility. Patients with perfusion fluids positive for fungi were further studied: the patients' status was assessed during regular visits and data were recorded, including clinical characteristics, infections, graft function, immunosuppressive regimen and outcomes. RESULTS Microbiologic, cultures of 70 kidney perfusion fluids using specific mycologic media, obtained from 74 cadaveric renal transplants (4 fluids were unsuitable for analysis), were evaluated. Six samples were positive for yeasts (8.6%), with 4 isolates of Candida albicans and 2 isolates of Candida glabrata. Four patients had no evidence of fungal infection during the follow-up period (median 321 days); conversely, 2 patients developed severe mycotic vascular complications leading to transplantectomy. CONCLUSIONS Perfusion fluid contamination by fungi is an elusive situation that can lead either to an unremarkable clinical course or to graft loss life-threatening situations. Routine culture of kidney perfusion fluid is critical for prompt diagnosis and early implementation of appropriate treatment.
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31
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Lladó L, Solé C, Bodro M, Baliellas C, Sabé N, Petit A, Ramos E, Carratalà J, Fabregat J. Candidaarteritis occurring in a liver transplant recipient. Transpl Infect Dis 2014; 16:465-8. [DOI: 10.1111/tid.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/18/2013] [Accepted: 12/18/2013] [Indexed: 01/16/2023]
Affiliation(s)
- L. Lladó
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - C. Solé
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - M. Bodro
- Infectious Diseases Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - C. Baliellas
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - N. Sabé
- Infectious Diseases Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - A. Petit
- Pathology Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - E. Ramos
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - J. Carratalà
- Infectious Diseases Department; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
| | - J. Fabregat
- Liver Transplant Unit; Hospital Universitari de Bellvitge - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL); University of Barcelona; Hospitalet de Llobregat; Barcelona Spain
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32
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Guy A, Chinai N, Ashley S, Rowe P, Cunningham R, Barwell J. Candida Arteritis in a Pair of Renal Transplant Recipients. EXP CLIN TRANSPLANT 2013; 11:558-61. [DOI: 10.6002/ect.2012.0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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33
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Aoubid Iaaza L, Bessede T, Eschwege P, Hammoudi Y, Durrbach A, Benoît G. Les anévrismes artériels anastomotiques après la transplantation rénale et pancréatique : diagnostic et traitement. Prog Urol 2013; 23:329-35. [DOI: 10.1016/j.purol.2012.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/13/2012] [Accepted: 11/09/2012] [Indexed: 01/13/2023]
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Affiliation(s)
- S. A. Fischer
- Transplant Infectious Diseases, Rhode Island Hospital. The Warren Alpert Medical School of Brown UniversityProvidenceRI
| | - K. Lu
- Center of Evidence‐Based Medicine, Division of Urology, Department of SurgeryE‐Da Hospital. I‐Shou UniversityTaiwan
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35
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Singh N, Huprikar S, Burdette SD, Morris MI, Blair JE, Wheat LJ. Donor-derived fungal infections in organ transplant recipients: guidelines of the American Society of Transplantation, infectious diseases community of practice. Am J Transplant 2012; 12:2414-28. [PMID: 22694672 DOI: 10.1111/j.1600-6143.2012.04100.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-derived fungal infections can be associated with serious complications in transplant recipients. Most cases of donor-derived candidiasis have occurred in kidney transplant recipients in whom contaminated preservation fluid is a commonly proposed source. Donors with cryptococcal disease, including those with unrecognized cryptococcal meningoencephalitis may transmit the infection with the allograft. Active histoplasmosis or undiagnosed and presumably asymptomatic infection in the donor that had not resolved by the time of death can result in donor-derived histoplasmosis in the recipient. Potential donors from an endemic area with either active or occult infection can also transmit coccidioidomycosis. Rare instances of aspergillosis and other mycoses, including agents of mucormycosis may also be transmitted from infected donors. Appropriate diagnostic evaluation and prompt initiation of appropriate antifungal therapy are warranted if donor-derived fungal infections are a consideration. This document discusses the characteristics, evaluation and approach to the management of donor-derived fungal infections in organ transplant recipients.
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Affiliation(s)
- N Singh
- University of Pittsburgh, PA, USA.
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36
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Yansouni CP, Dendukuri N, Liu G, Fernandez M, Frenette C, Paraskevas S, Sheppard DC. Positive cultures of organ preservation fluid predict postoperative infections in solid organ transplantation recipients. Infect Control Hosp Epidemiol 2012; 33:672-80. [PMID: 22669228 DOI: 10.1086/666344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The significance of positive cultures of organ preservation fluid (OPF) in solid organ transplantation is not known. We sought to describe the microbiology and define the clinical impact of positive OPF cultures. DESIGN Retrospective cohort study. SETTING Tertiary care hospital. PATIENTS A consecutive sample of all solid organ transplantations at our center between July 2006 and January 2009 was reviewed. A total of 331 allografts (185 kidneys, 104 livers, 31 pancreases, and 11 hearts) met the inclusion criterion of having OPF cultures taken from the transplanted allograft. METHODS Organisms recovered from OPF were classified as high or low risk according to their virulence. Clinical outcomes were compared between recipients of organs with positive OPF cultures and recipients of organs with negative OPF cultures. RESULTS OPF cultures were positive in 62.2% of allografts and yielded high-risk organisms in 17.8%. Normal skin flora constituted the majority of positive OPF cultures, while Enterobacteriaceae spp. and Staphylococcus aureus made up the majority of high-risk organisms. Recipients of allografts with positive OPF cultures developed more frequent bacterial infections, regardless of allograft type (relative risk, 2.39; 95% confidence interval [CI], 1.61-3.54). Moreover, isolation of a given organism in OPF samples was associated with the development of a clinical infection with the same organism, regardless of allograft type. CONCLUSIONS Positive cultures of OPF are common events in solid organ transplantation, frequently involve high-risk organisms, and are associated with the development of postoperative clinical bacterial infections. Further study is required to determine the optimal strategies for their prevention and management.
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Affiliation(s)
- Cedric P Yansouni
- Division of Infectious Diseases and Department of Medical Microbiology, McGill University Health Centre, Montreal, Quebec, Canada.
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37
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Loss of renal allografts secondary to Candida vascular complications in two recipients from the same donor. Case Rep Transplant 2012; 2012:364735. [PMID: 23213612 PMCID: PMC3504265 DOI: 10.1155/2012/364735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/30/2011] [Indexed: 11/20/2022] Open
Abstract
Infections remain a major cause of morbidity and mortality in transplant patients. Organ recipients are also susceptible to donor-derived pathogens and the majority of donor infections are easily treatable. Rarely, some pathogens have produced life-threatening complications by compromising the vascular anastomosis. In this case series we report loss of two kidney allografts secondary to vascular complications due to Candida albicans. Both recipients received grafts from a common donor, in whom Candida bacteremia in the donor was not apparent at the time of organ acceptance but became apparent on delayed cultures.
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38
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Risk factors for infection after liver transplantation. Best Pract Res Clin Gastroenterol 2012; 26:61-72. [PMID: 22482526 DOI: 10.1016/j.bpg.2012.01.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 11/10/2011] [Accepted: 01/13/2012] [Indexed: 01/31/2023]
Abstract
Infection is a common cause of morbidity and mortality after liver transplantation. Risk factors relate to transplantation factors, donor and recipient factors. Transplant factors include ischaemia-reperfusion damage, amount of intra-operative blood transfusion, level and type of immunosuppression, rejection, and complications, prolonged intensive care stay with dialysis or ventilation, type of biliary drainage, repeat operations, re-transplantation, antibiotics, antiviral regimen, and environment. Donor risk factors include infection, prolonged intensive care stay, quality of the donor liver (e.g. steatosis), and viral status. For the recipient the most important are MELD score >30, malnutrition, renal failure, acute liver failure, presence of infection or colonisation, and immune status for viruses like cytomegalovirus. In recent years it has become clear that genetic polymorphisms in innate immunity, especially the lectin pathway of complement activation and in Toll-like receptors importantly contribute to the infection risk after liver transplantation. Therefore, the risk for infections after liver transplantation is a multifactorial problem and all factors need attention to reduce this risk.
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De Rosa FG, Manzione NA, Ranghino A, Messina M, Ottobrelli A, Raviolo S, Di Perri G, Segoloni GP. Anidulafungin treatment in a kidney transplant recipient with hepatic damage. Mycoses 2011; 54 Suppl 4:12-5. [PMID: 22126524 DOI: 10.1111/j.1439-0507.2011.02137.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A 50-year old female was treated with anidulafungin after fluconazole treatment, for a complex clinical picture and immunosuppression. Anidulafungin was chosen when liver function test was abnormal in a setting of multiple causes of liver toxicity.
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Affiliation(s)
- Francesco G De Rosa
- Infectious Diseases Department, Ospedale Amedeo di Savoia, University of Turin, Italy.
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Candida albicans infections in renal transplant recipients: effect of caspofungin on polymorphonuclear cells. Antimicrob Agents Chemother 2011; 55:5936-8. [PMID: 21968354 DOI: 10.1128/aac.00521-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study aimed to compare the caspofungin immunomodulating activities against Candida albicans on polymorphonuclear cells (PMNs) from renal transplant recipients (RTRs) and healthy subjects (HSs). RTR PMNs showed a significantly reduced fungicidal activity compared with that of HS PMNs. Addition of caspofungin to RTR PMNs significantly potentiated the yeast intracellular killing rate, achieving values similar to those observed for HS PMNs. These data show that caspofungin is suitable for invasive candidiasis treatment in patients with immune system-impaired components.
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Veroux M, Corona D, Scriffignano V, Caglià P, Gagliano M, Giuffrida G, Gona F, Sciacca A, Giaquinta A, Oliveri S, Sinagra N, Tallarita T, Zerbo D, Sorbello M, Parrinello L, Veroux P. Contamination of preservation fluid in kidney transplantation: single-center analysis. Transplant Proc 2010; 42:1043-5. [PMID: 20534219 DOI: 10.1016/j.transproceed.2010.03.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Contamination of preservation fluid is common, with a reported incidence of 2.2% to 28.0%, and may be a major cause of early morbidity after transplantation. Herein, we report our experience with routine examination of preservation fluid collected just before implantation, focusing on the rate of contamination and the clinical consequences to recipients. MATERIALS AND METHODS We analyzed 62 samples of preservation fluid for microbial and fungal contamination. RESULTS Twenty-four samples (38.7%) were contaminated with at least 1 organism. Bacterial contamination alone was observed in 18 samples; all patients received prophylactic treatment with intravenous piperacillin/tazobactam, 4.5 g/d for 10 days, without clinical sequelae. Six samples were contaminated with Candida species; all patients received prophylactic treatment with fluconazole, 100 mg/d for 3 months. One patient developed reversible acute renal failure due to ureteral obstruction by fungus balls at 30 days after transplantation. CONCLUSION Contamination of preservation fluid occurs frequently after kidney transplantation. Bacterial contamination evolved without symptoms in most patients treated with prophylactic antibiotic therapy. Fungal contamination may be potentially life-threatening. However, graft nephrectomy is not mandatory if the involved Candida species is identified correctly and appropriate antifungal therapy is rapidly prescribed.
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Affiliation(s)
- M Veroux
- Department of Surgery, Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy.
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Yeast contamination of kidney, liver and cardiac preservation solutions before graft: need for standardisation of microbial evaluation. J Hosp Infect 2010; 76:52-5. [DOI: 10.1016/j.jhin.2010.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 02/05/2010] [Indexed: 01/16/2023]
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Janny S, Bert F, Dondero F, Durand F, Guerrini P, Merckx P, Nicolas-Chanoine MH, Belghiti J, Mantz J, Paugam-Burtz C. Microbiological findings of culture-positive preservation fluid in liver transplantation. Transpl Infect Dis 2010; 13:9-14. [PMID: 20738832 DOI: 10.1111/j.1399-3062.2010.00558.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacterial and fungal infections are the leading cause of mortality in liver transplant (LT) recipients. Few studies have examined the incidence of culture-positive preservation fluid (PF) and the outcome of related recipients. The aim of this study was to determine the incidence and the microbiologic findings of PF positive cultures, and to evaluate the impact on morbidity and mortality of LT recipients. A retrospective analysis of PF cultures performed after 477 LTs from cadaveric grafts between January 2001 and February 2008 was conducted. Forty-five (9.5%) PFs were found to be positive with 1 or 2 pathogens. The demographic profiles of recipients of PF with positive or negative cultures were similar. Enterobacteriaceae species were the most frequent organisms (n = 30), followed by Staphylococcus aureus (n = 5), coagulase-negative staphylococci (n = 5), enterococci (n = 4), and yeasts (n = 3). Mortality rate at 1 month was not significantly different in recipients with positive or sterile PF cultures (88.1% vs. 87.7%, respectively). The rate of bacteremia among LT recipients with positive or negative PF cultures was not statistically different. Systemic infections caused by the pathogen cultured from the PF occurred in 8 (18%) of the 45 recipients, including bacteremia (4/8) or intra-abdominal sepsis (5/8). Causative organisms were Enterobacteriaceae species (n = 5), Candida species (n = 2), and Enterococcus faecium (n = 1). Among the 8 patients who developed infection with the PF organism, 4 (50%) died in the intensive care unit (ICU) vs. an ICU mortality rate of 8% (3/37) in those who did not develop infection with the PF organism (P < 0.05). Infection occurred less frequently in recipients who received antimicrobial therapy with activity against the PF isolate than in those without appropriate treatment (41% vs. 3.8%, P < 0.005). Those who develop infection with organisms recovered from PF cultures appear to have high early mortality rates; therefore, appropriate antimicrobial therapy against organisms cultured from PF should be given.
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Affiliation(s)
- S Janny
- Department of Anesthesiology, Beaujon University Hospital, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.
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Affiliation(s)
- S. A. Fischer
- Department of Medicine and Transplant Services, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - R. K. Avery
- Department of Infectious Disease, The Cleveland Clinic, Cleveland, OH
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Sadegi BJ, Patel BK, Wilbur AC, Khosla A, Shamim E. Primary renal candidiasis: importance of imaging and clinical history in diagnosis and management. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:507-514. [PMID: 19321678 DOI: 10.7863/jum.2009.28.4.507] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Primary renal candidiasis is rare but increasing in incidence. The purpose of this series is to provide imaging and clinical findings for diagnosing candidiasis and to discuss imaging in the management of this disease. METHODS Ten sonographic, 8 retrograde pyelographic, 2 intravenous pyelographic, 2 antegrade pyelographic, and 2 computed tomographic examinations of 5 patients (4 adult male patients and 1 16-year-old female patient) were reviewed. RESULTS The clinical presentation was variable. Sonography showed renal pelvic wall thickening (n = 5), echogenic debris (n = 4), and fungus balls (n = 2). Papillary necrosis (n = 4), filling defects due to debris (n = 3), and fungus balls (n = 2) were seen on retrograde pyelography. CONCLUSIONS Untreated candidiasis may progress to fungus ball or abscess formation. Sonography is commonly used as the initial imaging procedure. Retrograde and antegrade pyelography are used for biopsy, diagnosis, and treatment. Awareness of this condition and knowledgeable imaging evaluation can help detect and define the site, infection severity, and subsequent therapy.
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Affiliation(s)
- Barry J Sadegi
- Department of Radiology, University of Illinois, Chicago, IL 60612, USA
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Albano L, Bretagne S, Mamzer-Bruneel MF, Kacso I, Desnos-Ollivier M, Guerrini P, Le Luong T, Cassuto E, Dromer F, Lortholary O. Evidence that graft-site candidiasis after kidney transplantation is acquired during organ recovery: a multicenter study in France. Clin Infect Dis 2009; 48:194-202. [PMID: 19090753 DOI: 10.1086/595688] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Laetitia Albano
- Service de Néphrologie, Hôpital Pasteur, Centre Hospitalo-Universitaire de Nice, Nice, France
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Taksin L, Mallick S, Frachet O, Julien M, Lepennec V, Ficheux M, Bensadoun H. [Mycotic aneurysm and renal transplant. A case report]. Prog Urol 2008; 19:149-52. [PMID: 19168023 DOI: 10.1016/j.purol.2008.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 10/07/2008] [Accepted: 10/20/2008] [Indexed: 12/27/2022]
Abstract
The arterial aneurysm secondary to Candida is a rare but frightening complication of renal transplant. We report the case of a 58-year-old patient who developed an arterial aneurysm secondary to a Candida infection in 3 weeks of a third renal transplant. Candida albicans was isolated from the preservation solution. The treatment consisted of a transplant nephrectomy, aneurysm excision and an iliac bypass with cryopreserved iliac homograft. All of bacteriologic culture was positive for Candida. The positive bacteriologic culture for Candida in preservation solution requires antifongic treatment. In case of arterial aneurysm, a surgical treatment is necessary but majority of kidney transplant had to be removed.
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Affiliation(s)
- L Taksin
- Service d'urologie, CHU Côte-de-Nacre, avenue Côte-de-Nacre, 14000 Caen, France.
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Canaud G, Timsit MO, Zuber J, Bougnoux ME, Méjean A, Thervet E, Snanoudj R, Sberro R, Martinez F, Legendre C, Mamzer-Bruneel MF. Early conservative intervention for candida contamination of preservative fluid without allograft nephrectomy. Nephrol Dial Transplant 2008; 24:1325-7. [PMID: 19004850 DOI: 10.1093/ndt/gfn622] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fungal contamination of kidney allograft preservative fluid can lead to renal arteritis and arterial wall rupture. METHODS We have evaluated a conservative management strategy based onearly antifungal therapy, rigorous morphological monitoring of the graft artery and surgical second look (SSL). Since November 2004, preservative fluid was routinely cultured on specific media for all kidney transplant recipients. RESULTS In 8/474 cases, results were positive for Candida (albicans 5, glabrata 2, tropicalis 1). Two patients also had candida infection of drainage fluid leading to the diagnosis of operative site infection. Radiological and surgical examinations of the renal graft artery were normal in all cases and nephrectomy was not required. At 12 months, all patients were alive with a functioning allograft. CONCLUSION Early antifungal therapy with microbiological and morphological follow-up should be recommended as soon as contamination is detected, but SSL is advised only in patients with risk factors for arterial anomalies.
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Affiliation(s)
- Guillaume Canaud
- Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France.
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