title: Candida species contamination of preservation fluid-outcome of renal transplantation in 6 patients.
abstract: BACKGROUND
  Fungal infections are a rare but important cause of morbidity and mortality in kidney transplantation. Fungal contamination of the kidney preservation fluid may, sometimes, be the cause of these infections. However, the clinical consequences of fungal contamination of this fluid are not completely understood and literature on this topic is controversial. The purpose of this study was to determine the incidence of preservation fluid contamination by fungi and its clinical consequences.
  
  
  METHODS
  From June 2010 to September 2011, a prospective cohort analysis was conducted at our center, enrolling all patients who received a renal allograft and whose perfusion fluid was analyzed for microbiology sterility. Patients with perfusion fluids positive for fungi were further studied: the patients' status was assessed during regular visits and data were recorded, including clinical characteristics, infections, graft function, immunosuppressive regimen and outcomes.
  
  
  RESULTS
  Microbiologic, cultures of 70 kidney perfusion fluids using specific mycologic media, obtained from 74 cadaveric renal transplants (4 fluids were unsuitable for analysis), were evaluated. Six samples were positive for yeasts (8.6%), with 4 isolates of Candida albicans and 2 isolates of Candida glabrata. Four patients had no evidence of fungal infection during the follow-up period (median 321 days); conversely, 2 patients developed severe mycotic vascular complications leading to transplantectomy.
  
  
  CONCLUSIONS
  Perfusion fluid contamination by fungi is an elusive situation that can lead either to an unremarkable clinical course or to graft loss life-threatening situations. Routine culture of kidney perfusion fluid is critical for prompt diagnosis and early implementation of appropriate treatment.
authors: Department of Nephrology, Hospital Fernando Fonseca, Lisboa, Portugal. bfgrodrigues@gmail.com
authors: B F
authors: BF
authors: Rodrigues
authors: A S
authors: AS
authors: Natário
authors: R S
authors: RS
authors: Vizinho
authors: C M
authors: CM
authors: Jorge
authors: A L
authors: AL
authors: Weigert
authors: A
authors: A
authors: Martinho
authors: C
authors: C
authors: Toscano
authors: T T
authors: TT
authors: Marques
authors: D S
authors: DS
authors: Machado
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification*; D041221:Candida glabrata / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D002675:Child, Preschool; D004340:Drug Contamination; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects*; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D019188:Organ Preservation Solutions