OBJECTIVE: To describe the successful repair of a post-transplant iliac artery aneurysm with renal graft preservation. METHODS: An aneurysm was detected in an asymptomatic 47-year-old male recipient on routine Doppler ultrasonography that involved the right external iliac artery and the distal portion of the renal artery. Aneurysm resection was performed immediately after diagnosis 3 months after transplantation. A polytetrafluorethylene tube graft was used for reconstruction of the right external iliac artery. Reconstruction of the renal artery required interposition of a vena saphena graft between the proximal portion of the renal artery and the polytetrafluorethylene tube. RESULTS: The total warm ischemia time used for aneurysm repair and renal transplant revascularization was 90 minutes. The postoperative Doppler ultrasound scan showed homogeneous graft perfusion. Pathologic and microbiologic examination of the resected aneurysm revealed Candida albicans arteritis. The center in which the contralateral donor kidney was transplanted had previously reported Candida albicans contamination of the preservation solution. The recipient of the contralateral kidney lost his graft owing to bleeding complications. Information on this incident was acquired by our center only after aneurysm repair. Postoperatively, our recipient was given systemic antifungal therapy. At 6 months, the serum creatinine level was 1.7 mg/dL. CONCLUSION: Although a high-risk procedure, repair of a mycotic aneurysm with renal graft preservation is feasible. Routine microbiologic screening of the preservation solution might help to detect and treat donor-transmitted infections in renal transplant recipients.
OBJECTIVE: To describe the successful repair of a post-transplant iliac artery aneurysm with renal graft preservation. METHODS: An aneurysm was detected in an asymptomatic 47-year-old male recipient on routine Doppler ultrasonography that involved the right external iliac artery and the distal portion of the renal artery. Aneurysm resection was performed immediately after diagnosis 3 months after transplantation. A polytetrafluorethylene tube graft was used for reconstruction of the right external iliac artery. Reconstruction of the renal artery required interposition of a vena saphena graft between the proximal portion of the renal artery and the polytetrafluorethylene tube. RESULTS: The total warm ischemia time used for aneurysm repair and renal transplant revascularization was 90 minutes. The postoperative Doppler ultrasound scan showed homogeneous graft perfusion. Pathologic and microbiologic examination of the resected aneurysm revealed Candida albicans arteritis. The center in which the contralateral donor kidney was transplanted had previously reported Candida albicans contamination of the preservation solution. The recipient of the contralateral kidney lost his graft owing to bleeding complications. Information on this incident was acquired by our center only after aneurysm repair. Postoperatively, our recipient was given systemic antifungal therapy. At 6 months, the serum creatinine level was 1.7 mg/dL. CONCLUSION: Although a high-risk procedure, repair of a mycotic aneurysm with renal graft preservation is feasible. Routine microbiologic screening of the preservation solution might help to detect and treat donor-transmitted infections in renal transplant recipients.
Authors: Marco Bindi; Mariano Ferraresso; Maria Letizia De Simeis; Nicholas Raison; Laura Clementoni; Serena Delbue; Marta Perego; Evaldo Favi Journal: World J Clin Cases Date: 2020-03-06 Impact factor: 1.337
Authors: Nasrin El-Bandar; Daniela C Kroy; Tom Florian Fuller; Jürgen Kramer; Lutz Liefeldt; Klemens Budde; Conrad Blobel; Kurt Miller; Frank Friedersdorff Journal: Am J Case Rep Date: 2017-07-11
Authors: Yazin Marie; Avneesh Kumar; Sarah Hinchliffe; Simon Curran; Peter Brown; Douglas Turner; Badri Shrestha Journal: World J Transplant Date: 2018-10-22