Candida vascular complication (liver)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
In liver transplantation, positivity rate in organ preservation fluid is quoted to be in the 0.4-4.1% range. Rate of transmission of infection leading to disease in recipient is low.
Time to detection: 
22 days
Alerting signals, symptoms, evidence of occurrence: 
Abdominal pain and fever at presentation, scan revealed a large peri-hepatic hematoma from where C. albicans was grown. Started on Caspofungin. On POD 40, the patient presented in hemorrhagic shock, with complete disruption of arterial anastomosis on the CT scan. Surgical exploration showed complete disruption of the arterial anastomosis with a mycotic aneurysm of the hepatic artery. Intra-peritoneal cultures and explant hepatic artery grew C. albicans. Switched to fluconazole and liposomal amphotericin B. On POD 70, the patient died from refractory septic shock due to peritonitis and gut ischemia with multiple organ failure.
Demonstration of imputability or root cause: 
No comparative analysis of strains from the preservation fluid and liver recipient. Kidney preservation fluid culture from same donor was negative.
Imputability grade: 
2 Probable
Suggest new keywords: 
fever, abdominal pain, haemmorhagic shock, mycotic aneurism,
Reference attachment: 
Suggest references: 
Candida vascular complication in a liver transplant recipient due to yeast contamination of preservation solution. Levesque E et al. Transpl Infect Dis. 16(5):827-9, 2014 Oct.
Expert comments for publication: 
Another publication from the same group describes a 5-year (2008–2012) large retrospective multicentre study involving six French liver transplantation centers and the incidence of Candida preservation fluid contamination does not address the origin of the infection but gives outocomes and management details which may be on interest (Levesque et al, Transplant International 2015;28:1308-16.)