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NDT Advance Access originally published online on November 11, 2008
Nephrology Dialysis Transplantation 2009 24(4):1325-1327; doi:10.1093/ndt/gfn622
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Early conservative intervention for candida contamination of preservative fluid without allograft nephrectomy

Guillaume Canaud1,2*, Marc-Olivier Timsit3,*, Julien Zuber1,2, Marie-Elisabeth Bougnoux2,4, Arnaud Méjean3,2, Eric Thervet1,2, Renaud Snanoudj1, Rebecca Sberro1,2, Frank Martinez1, Christophe Legendre1,2 and Marie-France Mamzer-Bruneel1

1 Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015 2 Université Paris Descartes, Rue de l’Ecole de Médecine, 75007 3 Department of Urology, Necker Hospital, 149 rue de Sèvres 4 Laboratory of mycology, Necker Hospital, 149 rue de Sèvres, 75015, Paris, France

Correspondence and offprint requests to: Guillaume Canaud, Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France. Tel: +33-144495432; Fax: +33-14449 5435; E-mail: guillaume.canaud{at}nck.aphp.fr



  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.

Conclusion. 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.

Keywords: arteritis; candida; management nephrectomy; rupture

* Both authors contributed equally to this work.

Received for publication: 11. 8.08
Accepted in revised form: 14.10.08


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