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Updated: Jun 12, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
Malakoplakia among kidney transplant recipients: case series and literature review
Ali B Abbasi1, Gerardo Gamino2, Alan Zambeli-Ljepović1
1Department of Surgery, University of California, San Francisco, San Francisco, CA, United States.
Abstract:
We report two cases of malakoplakia after kidney transplant, a rare granulomatous condition that occurs primarily in immunocompromised patients and his thought to occur due to incomplete clearance of phagocytized bacterial residue by macrophages. Both patients were at heightened immunological risk due to being highly sensitized or prior episodes of rejection, both experienced E. Coli infections in the first 4 months after transplant, and both presented with granulomatous masses that were biopsied and confirmed to be malakoplakia. Both were treated with suppressive antibiotics and required urinary drainage of the transplant kidney, resulting in improvements in the size of the mass on imaging. Given that both patients were at heightened immunological risk due to sensitization or episodes of rejection, we sought to investigate whether these are common risk factors for malakoplakia in the published literature. We summarized 59 published reports of malakoplakia in kidney transplant recipients. We found that malakoplakia cases predominantly occur in the first two years after transplant and that 47% of patients had either prior rejection or a prior transplant. We also found that many case reports of malakoplakia involve E. Coli infections and that improvement or resolution of malakoplakia was more common in case reports that did not involve surgical resection of the mass.
Insights
Malakoplakia, a rare granulomatous condition, can occur after kidney transplant, especially in immunocompromised patients. Risk factors include heightened immunological risk and E. coli infections, with antibiotic treatment often improving outcomes.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Malakoplakia is a rare granulomatous condition primarily affecting immunocompromised individuals.
- It is thought to result from impaired macrophage clearance of bacterial debris.
- Kidney transplant recipients are at risk due to immunosuppression.
Purpose of the Study:
- To investigate risk factors and outcomes of malakoplakia in kidney transplant recipients.
- To analyze the association between immunological risk factors and malakoplakia development.
- To review treatment strategies and their effectiveness.
Main Methods:
- Case report of two kidney transplant recipients with malakoplakia.
- Literature review of 59 published cases of malakoplakia in kidney transplant recipients.
- Analysis of patient data for risk factors, infections, and treatment outcomes.
Main Results:
- Malakoplakia predominantly occurs within two years post-transplant.
- 47% of reviewed patients had prior rejection or a previous transplant.
- E. coli infections were frequently reported; antibiotic therapy and urinary drainage showed improvement.
- Non-surgical management was associated with better outcomes.
Conclusions:
- Heightened immunological risk (sensitization, rejection history) and E. coli infections are significant risk factors for malakoplakia post-kidney transplant.
- Early diagnosis and management with suppressive antibiotics and urinary drainage can lead to improvement.
- Conservative management may be preferred over surgical resection for better outcomes.
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