title: Evidence that graft-site candidiasis after kidney transplantation is acquired during organ recovery: a multicenter study in France.
abstract: BACKGROUND
  Infections of renal grafts with Candida species can induce life-threatening complications in the recipient.
  
  
  METHODS
  A 9-year retrospective study involving all of the transplant centers in France was designed to determine the incidence, origin, characteristics, and outcome of graft-site candidiasis that occurred after kidney transplantation. Yeasts cultured from preservation or drainage solutions and graft specimens were recorded.
  
  
  RESULTS
  Among 18,617 kidney grafts, 18 recipients corresponding to 12 donors developed culture-confirmed graft-site candidiasis (incidence, 1 case per 1000 grafts) a median of 25 days after the graft procedure. Clinical presentations included 14 cases of renal arteritis (13 were complicated by aneurysm), 1 urinoma, 2 graft site abscesses, and 1 surgical site infection. Candida albicans was involved in 13 cases. A unique C. albicans genotype or a single rare Candida species was involved in each episode. Together with the clinical history, these findings demonstrate that organ contamination followed by transmission to the recipient occurred during recovery. Therapeutic management varied from simple monitoring in 1 case to a combination of surgery (nephrectomy in 9 cases and arterial bypass in 9 cases) and antifungal therapy (14 cases). Overall, 3 of 18 kidney transplant recipients died, and 9 had their graft surgically removed.
  
  
  CONCLUSIONS
  Graft-transmitted candidiasis that ends most often in fungal arteritis is associated with high morbidity and mortality after kidney transplantation and is related to organ contamination during recovery in the donor.
authors.affiliation: Service de Néphrologie, Hôpital Pasteur, Centre Hospitalo-Universitaire de Nice, Nice, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Albano
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Mamzer-Bruneel
authors.forename: Irina
authors.initials: I
authors.lastname: Kacso
authors.forename: Marie
authors.initials: M
authors.lastname: Desnos-Ollivier
authors.forename: Patrice
authors.initials: P
authors.lastname: Guerrini
authors.forename: Thanh
authors.initials: T
authors.lastname: Le Luong
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cassuto
authors.forename: Françoise
authors.initials: F
authors.lastname: Dromer
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000328:Adult; D000368:Aged; D002175:Candida / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005602:France / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome