[Vascular Aspergillus infection in two recipients of kidneys from the same donor].
We describe a clinical case of two patients who received a cadaveric renal graft from the same donor in a multi-organ extraction procedure. The donor was a 39-years-old woman who died of intracranial tumour. A benign ganglioma was shown in biopsy. The two recipients received the same immunosuppressive regimen. Induction comprised cyclosporin A, steroids and basiliximab while cyclosporin A and steroids were used in maintenance immunosuppression. The A patient was a 53-year-old woman with chronic renal failure due to chronic pyelonephritis. She had been undergoing periodic haemodialysis for five years. She was hospitalised for sciatic pain refractory to rest and analgesics 35 days after transplantation. Two days later, her graft function deteriorated. Ultrasonography ruled out a urinary tract obstruction. Cyclosporine levels was normal. It was interpreted as an acute rejection episode and was treated with boluses of methylprednisolone (500 mg for 3 days). At the same time, her right leg began to show paraesthesia, coldness and a decreased arterial pulse. A spinal magnetic nuclear resonance was performed. It showed an aneurysm of right common iliac artery (fig. 1). An arteriography confirmed the existence of a pseudoaneurysm and an arteriovenous fistula to inferior vena cava (fig. 2). The B recipient was a 56-year-old woman with chronic renal failure due to chronic pyelonephritis. She required haemodialysis for two years. In the 4th month after transplantation her graft function deteriorated. Graft biopsy did not show acute cellular rejection, so she was kept on immunosuppressive treatment. A second graft biopsy was taken and no changes with the previous one was observed. Renal function deteriorated and haemodialysis was required. During the 6th month she began to show paraesthesia, coldness and decreased arterial pulse in her right leg. Ultrasonography showed pyelocaliectasis with an adjacent solid-liquid mass, abdominal CT scan confirmed. Arteriography proved the presence of a pseudoaneurysm of the right common iliac artery (fig. 3). Transplantectomy and pseudoaneurysm resection was performed in the two cases. Culture analysis revealed fungi identified as Aspergillus in both pseudoaneurysms. Medical treatment was started immediately with liposomal amphotericin B. The clinical evolution of the two recipients were different. While recipient A died, B patient recovered, requiring haemodialysis.
Garrido
J
J
Servicio de Nefrología, Hospital Clínico Universitario de Salamanca, Salamanca.
Labrador
P J
PJ
Lerma
L
L
Heras
M
M
García
P
P
Bondía
A
A
Corbacho
L
L
Tabernero
M
M
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D017541:Aneurysm, False / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D000785:Aneurysm, Infected / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000635:transmission*; D000077552:Basiliximab; D002102:Cadaver; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000382:microbiology; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008081:Liposomes; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D011704:Pyelonephritis / Q000601:surgery; D011993:Recombinant Fusion Proteins; D014019:Tissue Donors; D019737:Transplants / Q000009:adverse effects* / Q000382:microbiology; D014682:Vena Cava, Inferior / Q000382:microbiology
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D008081:Liposomes; D011993:Recombinant Fusion Proteins; C068538:liposomal amphotericin B; D000666:Amphotericin B; D016572:Cyclosporine; D000077552:Basiliximab