Candida albicans arteritis transmitted by preservation fluid after liver transplantation

Area of Science:

• Transplantation Medicine
• Infectious Diseases
• Mycology

Background:

• Fungal infections are a significant cause of mortality in immunosuppressed liver transplant (LT) patients.
• Contamination of preservation fluid (PF) with bacteria and fungi poses a risk to LT recipients.

Observation:

• A liver transplant patient with alcoholic cirrhosis developed a Candida albicans infection originating from contaminated PF.
• The patient later presented with hemobilia due to a mycotic arteritis of the graft artery, confirmed to be the same Candida albicans strain.
• Initial antimycotic prophylaxis did not prevent the delayed development of this serious complication.

Findings:

• Mycotic arteritis, a rare but severe complication, can arise from yeast contamination of liver graft preservation fluid.
• Candida albicans in PF can lead to arterial pseudoaneurysms and fistulas in the biliary anastomosis.
• The same fungal genotype was identified in both the PF and the affected arterial segment, confirming the source of infection.

Implications:

• Healthcare providers must be vigilant for mycotic arteritis in liver transplant patients, even with initial prophylaxis.
• Early identification and management of fungal contamination in preservation fluid are critical to prevent severe outcomes.
• Awareness of this complication is essential for improving patient outcomes in liver transplantation.