Malakoplakia in kidney transplant recipients: Three case reports

Area of Science:

• Nephrology
• Transplant Surgery
• Infectious Diseases

Background:

• Malakoplakia is a rare granulomatous disease linked to gram-negative infections, particularly Escherichia coli, stemming from impaired macrophage phagolysosomal function.
• While typically affecting the urinary bladder, malakoplakia can impact any solid organ, including native and transplanted kidneys, with isolated kidney allograft involvement being infrequent.
• Kidney transplant recipients, often on immunosuppression, are at increased risk for developing malakoplakia.

Observation:

• This case series details three instances of kidney allograft parenchymal malakoplakia in immunosuppressed transplant recipients, all successfully managed.
• A literature review identified 55 cases of malakoplakia in kidney transplant recipients, with 27 involving the allograft.
• Common clinical presentations included allograft dysfunction, pyelonephritis, and mass lesions within the allograft or systemically.

Findings:

• Successful management strategies for kidney allograft malakoplakia primarily involve prolonged antibiotic therapy and modification of immunosuppression.
• The majority of reported cases in kidney transplant recipients achieved favorable outcomes with appropriate medical intervention.
• Analysis of documented cases highlights the etiology, clinical presentation, pathogenesis, and effective management protocols for malakoplakia in this patient population.

Implications:

• This study underscores the importance of considering malakoplakia in kidney transplant recipients presenting with allograft dysfunction or mass lesions.
• Early diagnosis and tailored management, including antibiotic treatment and immunosuppression adjustment, are crucial for favorable outcomes in kidney allograft malakoplakia.
• Further research into the pathogenesis and optimal treatment strategies for malakoplakia in transplant recipients can improve patient care and graft survival.