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Adverse Occurrence type:
Rate of donor-derived transmisison of Candida spp is low but it has the potential to cause severe complications.
Time to detection:
37 to 59 days
Alerting signals, symptoms, evidence of occurrence:
Prospective single centre study over a one year period; 74 kidney preservation fluid samples were cultured, with an isolation rate of 8.6% (see comments below). Presentation can be of abrupt onset with hypovolemic shock due to rupture of mycotic aneurism, while others have a more indolent course with fever, abdominal pain and worsening renal function, with imaging techniques revealing structural arterial lesions.
Demonstration of imputability or root cause:
Candida albicans isolated from preservation fluid in one kidney, with the contralateral one yielding negative culture. The patient who received the kidney with positive culture developed complications but the other patient remained well. Neither received anti-fungal prophylaxis. No data on antifungal suscptibility profile or molecular analysis were presented.
Suggest new keywords:
Candida albicans; mycotic aneurism; vascular complications; nephrectomy; organ preservation fluid
Candida species contamination of preservation fluid-outcome of renal transplantation in 6 patients. Rodrigues BF et al. Transplant Proc. 45(6):2215-9, 2013 Jul-Aug.
Expert comments for publication:
Peritoneal contamination with donor strain during multi-abdominal organ recovery is not a frequent event but when transmission occurs and there is no intervention, the risk of significant complication is high. Rate of Candida spp isolation from organ preservation fluid varies widely; in this small, single centre study it was 8.6%, with 33% rate of complication (2 out of 6). There is no consensus on the use and duration of anti-fungal prophylaxis in renal transplanttaion where preservation fluid culture is positive and management is largely based on local experience. Culture of preservation fluid is not universally applied and great variation in microbiological methodology makes cross site comparison very difficult.