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Updated: May 25, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
Donor-Derived Aspergillosis Following Kidney Transplantation: A Case Report
Michael A Deal1, John J Nunnery1, Stephen Patrick1
1Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
Introduction:
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.
Case Presentation:
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.
Conclusion:
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.
Insights
Donor-derived aspergillosis following kidney transplant is rare but can be fatal. This case highlights the need for better donor screening and faster communication between organ procurement organizations and transplant centers to prevent severe outcomes.
Area of Science:
- Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Kidney transplantation improves patient outcomes but carries risks of complications.
- Donor-derived infections, including rare cases of aspergillosis, can cause significant morbidity and mortality.
- Limited data exists on donor-derived aspergillosis, necessitating case reports for awareness.
Purpose of the Study:
- To present a rare case of donor-derived aspergillosis after kidney transplantation.
- To underscore the severe consequences of this infection, including multisystem organ failure, graft loss, and death.
- To advocate for enhanced donor screening and improved communication in organ transplantation.
Main Methods:
- A case report of a 72-year-old male recipient of a kidney transplant.
- Description of the patient's clinical presentation, diagnostic workup, and treatment course.
- Identification of aspergillosis in the explanted kidney and confirmation of donor origin.
Main Results:
- The patient developed fevers, chills, and sepsis despite broad-spectrum antibiotics for Enterococcus faecalis.
- Multifocal pyelonephritis was diagnosed, leading to transplant nephrectomy.
- Intraoperative cultures revealed aspergillosis, later confirmed as donor-derived, resulting in graft loss and patient death.
Conclusions:
- Donor-derived aspergillosis is a rare but severe complication of kidney transplantation.
- Improved screening protocols for rare fungal infections in organ donors are crucial.
- Timely communication between Organ Procurement Organizations and transplant centers is vital for patient management.
