Evidence That Graft-Site Candidiasis after Kidney Transplantation Is Acquired during Organ Recovery: A Multicenter Study in France

Clinical Infectious Diseases, Jan 2009

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. Conclusion.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.

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Evidence That Graft-Site Candidiasis after Kidney Transplantation Is Acquired during Organ Recovery: A Multicenter Study in France

Laetitia Albano 0 2 4 5 9 10 11 St ephane Bretagne 0 1 2 3 4 9 10 11 Marie-France Mamzer-Bruneel 0 2 4 8 9 10 11 Irina Kacso 0 2 4 5 9 10 11 Marie Desnos-Ollivier 0 1 2 4 9 10 11 Patrice Guerrini 0 2 4 7 9 10 11 Thanh Le Luong 0 2 4 7 9 10 11 Elisabeth Cassuto 0 2 4 5 9 10 11 Franc oise Dromer 0 1 2 4 9 10 11 Olivier Lortholary 0 1 2 4 6 9 10 11 for the French Mycosis Study Group 0 2 4 9 10 11 0 related to exogenous sources in the hospital setting [3] 1 Unite de Mycologie Moleculaire, Institut Pasteur, Centre National de Reference Mycologie et Antifongiques 2 enous origin attributable to intestinal translocation or 3 Service de Parasitologie-Mycologie , Faculte de Medecine Paris XII, Hopital Henri Mondor Assistance Publique-Hopitaux de Paris, Creteil 4 Received 2 July 2008; accepted 3 October 2008; electronically published 17 December 2008. Presented in part: 46th Interscience Conference on Antimicrobial Agents and Chemotherapy , San Francisco, California , 27-30 September 2006 (abstract M-875). Centre National de Reference Mycologie et Antifongiques , CNRS URA3012, Institut Pasteur 25 , rue du Dr Roux, 75724 Paris Cedex 15, France 5 Service de Nephrologie , Hopital Pasteur, Centre Hospitalo-Universitaire de Nice , Nice 6 Service des Maladies Infectieuses et Tropicales , Faculte de Medecine Paris Descartes, Hopital Necker-Enfants Malades Assistance Publique-Hopitaux de Paris, Centre d'Infectiologie Necker-Pasteur , Paris, France 7 Agence de la Biomedecine, Saint Denis 8 Service de Transplantation Renale , Faculte de Medecine Paris Descartes, Hopital Necker-Enfants Malades Assistance Publique-Hopitaux de Paris 9 was alerted by the occurrence of several cases of severe 10 Antifungals (NRCMA; Institut Pasteur , Paris, France) 11 Since the National Reference Center for Mycoses 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-conf rmed 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 f ndings 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. Conclusion. 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. Infection with Candida species remains a frequent cause of morbidity after solid-organ transplantation [1], with invasive candidiasis occurring at a prevalence of 5% in kidney transplant recipients and 20% in liver transplant recipients [2]. Invasive candidiasis is either of endog- - Candida arteritis in kidney transplant recipients, a multicenter, retrospective study involving all kidney transplant centers in France has been designed to investigate the route of acquisition of graft site candidiasis and to better describe this clinical entity and its outcomes. PATIENTS AND METHODS Study design. A collaborative, retrospective, multicenter study was designed in 2006 that involved all 37 adult kidney transplant centers in France; the goal was to record all cases of infection with Candida species at graft sites from 1997 (f rst notificatio in France) through 2005. Data with regard to the donors and organ recipients were provided by the French Biomedicine Agency. The database on solid organ procurements and transplantation was used to ascertain the number of kidney transplantations that occurred in France during the study period. All of the data were recorded anonymously. Every recipient who had at least 1 sample (obtained from an artery, vein, or pus or drainage from the surgical site) that was culture positive for Candida species was considered to be infected. We collected information regarding recipients and donors with use of a standardized questionnaire. An episode included events related to the donor and the corresponding organ recipients. Mycologi (...truncated)


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Laetitia Albano, Stéphane Bretagne, Marie-France Mamzer-Bruneel, Irina Kacso, Marie Desnos-Ollivier, Patrice Guerrini, Thanh Le Luong, Elisabeth Cassuto, Françoise Dromer, Olivier Lortholary, for the French Mycosis Study Group. Evidence That Graft-Site Candidiasis after Kidney Transplantation Is Acquired during Organ Recovery: A Multicenter Study in France, Clinical Infectious Diseases, 2009, pp. 194-202, 48/2, DOI: 10.1086/595688