Donor-Derived Aspergillosis Following Kidney Transplantation: A Case Report

While kidney transplantation can improve both quality and quantity of life in patients with renal disease, there are well-described possible surgical and medical complications. Of these complications, donor-derived infections represent a source of morbidity and mortality. Donor-derived aspergillosis is a rare source of these infections. Given the limited number of reported cases of donor-derived aspergillosis, we present a case that resulted in multisystem organ failure, graft loss, and death.

A 72-year-old male underwent renal transplantation. Two months later, the patient presented with fevers, chills, weakness, and right lower quadrant pain. His early hospital course was notable for blood and urine cultures positive for Enterococcus faecalis, which was treated with broad spectrum antibiotics. Despite appropriate treatment, the patient ultimately required ICU admission, intubation, and initiation of vasopressors. After additional diagnostic imaging revealed multifocal pyelonephritis, the patient underwent transplant nephrectomy with intraoperative cultures revealing aspergillosis. Shortly following transplant nephrectomy, we were notified by the Organ Procurement Organization (OPO) that this likely represented a donor-derived infection. Our patient was initiated on appropriate antifungal coverage, though had continued respiratory and hemodynamic compromise and was ultimately transitioned to comfort care. He expired shortly thereafter.

In reporting this rare case, we hope to increase awareness of the significant illness severity and associated complications with donor-derived aspergillosis. Additionally, we highlight the need for improved screening for rare organisms in donors and for decreased communication delays between the OPO and transplant centers.