title: Early conservative intervention for candida contamination of preservative fluid without allograft nephrectomy.
abstract: 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.
authors.affiliation: Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France. guillaume.canaud@nck.aphp.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Canaud
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Timsit
authors.forename: Julien
authors.initials: J
authors.lastname: Zuber
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Bougnoux
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.forename: Eric
authors.initials: E
authors.lastname: Thervet
authors.forename: Renaud
authors.initials: R
authors.lastname: Snanoudj
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sberro
authors.forename: Frank
authors.initials: F
authors.lastname: Martinez
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Mamzer-Bruneel
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D019188:Organ Preservation Solutions