Status:
Ready to upload
Record number:
1643
Adverse Occurrence type:
MPHO Type:
Time to detection:
10 - 22 days
Alerting signals, symptoms, evidence of occurrence:
The first recipient presented on post operative day 10 with sudden complaint of diffuse abdominal pain radiating to the right leg. The clinical examination revealed abdominal distension with generalized tenderness and massive wound bleeding. Severe hemorrhage in the area of graft anastomosis led to loss of the graft. Periodic acid-Schiff staining of the renal artery wall revealed budding yeast, forming pseudohyphae. The second recipient developed pain on the graft site on day 22 and ultrasound revealed pseudoaneurysm close to the graft anastomosis, confirmed by computed tomography angiography.
Demonstration of imputability or root cause:
Candida albicans was isolated from oral and respiratory secretions from the common donor. Both kidney recipients developed Candida arteritis. Preservation fluid was cultured, with isolation of E. coli. Selective fungal medium was not used and the presence of E.coli might have hampered yeast growth. No isolates were available for characterisation, anti fungal susceptibility was not reported. Although liver was retrieved, authors do not mention whether liver was transplanted and if so, what happened to the recipient.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
Candida albicans; arteritis; infection; mycotic arteritis; renal transplant
Abdominal pain
Preservation fluid
Mycotic aneurism
Abdominal distension
Reference attachment:
Suggest references:
Transpl Infect Dis. 2015 Jun;17(3):449-55. doi: 10.1111/tid.12388. Epub 2015 May 26
Expert comments for publication:
Authors discuss the need of appropriate microbiological methods for culture of preservation fluid, if contamination at retrieval is to be excluded. Heavy E. coli growth in preservation fluid supports contamination with gastrointestinal micro organisms, which can occur in abdominal multi organ retrieval, particularly involving liver and pancreas, even in the absence of reported breach of gastrointestinal mucosa.