[Massive hemorrhage caused by fungal infections after donation-after-cardiac-death kidney transplantation: clinical features, prevention and treatment experience].
OBJECTIVE
To study the characteristics and prevention and treatment strategies of massive hemorrhage caused by fungal infections after donation-after-cardiac-death (DCD) kidney transplantation.


METHODS
A total of 91 cases of DCD kidney transplantation between August 25, 2013 and June 30, 2015 in Third Affiliated Hospital of Sun Yat-sen Univservity were retrospectively analyzed. The characteristics of and prevention and treatments strategies for postoperative massive hemorrhage caused by fungal infections were summarized.


RESULTS
Ninety-one cases of DCD kidney transplantation were divided into 2 groups based on regimens for preventing postoperative fungal infections: fluconazole prophylaxis group: a total of 26 cases of renal transplant before June 11, 2014 received fluconazole regimen, from postoperative day 0 to 2 weeks; micafungin prophylaxis group: a total of 65 cases of renal transplant after June 11, 2014 received micafungin regimen, also for 2 weeks from postoperative day 0. Two cases in fluconazole group developed postoperative massive hemorrhage. In case 1, the hemorrhage occurred at 2 weeks after transplantation. Graft nephrectomy was performed during surgical exploration for hemostasis, yet the massive hemorrhage relapsed 2 weeks later. Endoluminal exclusion of external iliac artery using endovascular covered stent-graft at the anastomosis site was performed and the massive bleeding was successfully stopped. The patient was restored to hemodialysis and waited for second kidney transplantation. Candia albicans was detected in the culture of blood and drainage liquid from incision. The other case of hemorrhage occurred at 3 weeks after transplantation. Graft nephrectomy plus endovascular exclusion using covered stent-graft were also performed to stop the massive bleeding. Massive fungal hyphae and spores were observed at the stump of renal graft artery under microscope. The patient received second kidney transplantation after 6 months successfully. No massive hemorrhage caused by fungal infections occurred in micafungin prophylaxis group.


CONCLUSIONS
Massive hemorrhage cased by fungal infections after DCD kidney transplantation is usually characterized by delayed and recurrent course, and may result in graft nephrectomy or even death of patients. Endovascular exclusion using covered stent can successfully stop bleeding and rescue life of patients. Two-week preemptive prophylaxis of fungal infections using micafungin can effectively prevent delayed fungal massive hemorrhage in DCD kidney transplantation.
Department of Kidney Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510760, China.
D D
DD
Zhao
Z Y
ZY
Huang
L Q
LQ
Hong
T
T
Liao
Y E
YE
Tang
N
N
Na
H
H
Li
B
B
Miao
X F
XF
Hua
Q Q
QQ
Sun
D000935:Antifungal Agents / Q000627:therapeutic use; D054714:Echinocandins / Q000627:therapeutic use; D006331:Heart Diseases / Q000401:mortality; D006470:Hemorrhage / Q000821:virology; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation; D055666:Lipopeptides / Q000627:therapeutic use; D000077551:Micafungin; D009181:Mycoses / Q000517:prevention & control*; D009392:Nephrectomy; D011183:Postoperative Complications / Q000821:virology*; D012077:Renal Artery; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin