Early conservative intervention for candida contamination of preservative fluid without allograft nephrectomy.
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.


CONCLUSIONS
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.
Canaud
Guillaume
G
Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France. guillaume.canaud@nck.aphp.fr
Timsit
Marc-Olivier
MO
Zuber
Julien
J
Bougnoux
Marie-Elisabeth
ME
Méjean
Arnaud
A
Thervet
Eric
E
Snanoudj
Renaud
R
Sberro
Rebecca
R
Martinez
Frank
F
Legendre
Christophe
C
Mamzer-Bruneel
Marie-France
MF
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000209:etiology* / Q000628:therapy; D004340:Drug Contamination; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology* / Q000628:therapy; D014184:Transplantation, Homologous; D055815:Young Adult
D000935:Antifungal Agents; D019188:Organ Preservation Solutions