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Updated: Jan 17, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Two Cases of Post-Kidney Transplantation Thrombotic Microangiopathy From a Single Donor With Candidemia
Tiffany Shi1, William H Schwieterman2, Olanrewaju Eletta2
1Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Medical Scientist Training Program, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Abstract:
Thrombotic microangiopathy (TMA) secondary to donor-derived infections remains a rare, yet serious source of graft loss and increased patient morbidity and mortality. Among TMA etiologies, donor-derived fungal infections remain particularly challenging to test for pre-operatively and treat post-operatively. We describe 2 cases of post-kidney transplant TMA from a single donor with suspected candidemia. Despite prophylactic treatment for Candida with fluconazole and eculizumab for TMA, 1 of the 2 patients unfortunately succumbed to TMA-related complications. The other patient, who also received fluconazole and eculizumab, had persistent hemolysis and ultimately required a transplant nephrectomy. Following nephrectomy, the patient's symptoms and laboratory values improved and the patient was able to be discharged to inpatient rehab before returning home. Despite appropriate treatment for Candida and TMA, patient outcomes were unfavorable. These 2 cases underscore the difficulties in treating TMA in the setting of organ transplantation and candidemia, pointing to the necessity for more research into improved treatment approaches.
Insights
Donor-derived fungal infections causing thrombotic microangiopathy (TMA) after kidney transplants are challenging. Despite treatment, outcomes were poor in two cases, highlighting the need for better therapeutic strategies.
Area of Science:
- Nephrology
- Transplantation Immunology
- Infectious Diseases
Background:
- Thrombotic microangiopathy (TMA) post-kidney transplant, especially from donor-derived infections, can lead to graft loss and mortality.
- Donor-derived fungal infections, particularly Candida, present diagnostic and therapeutic challenges in transplant recipients.
Purpose of the Study:
- To describe two cases of post-kidney transplant TMA secondary to a single donor with suspected candidemia.
- To highlight the difficulties in managing TMA in the context of organ transplantation and fungal infections.
Main Methods:
- Case report of two kidney transplant recipients who developed TMA.
- Treatment involved prophylactic fluconazole for Candida and eculizumab for TMA.
Main Results:
- One patient died from TMA-related complications.
- The second patient experienced persistent hemolysis, requiring transplant nephrectomy for symptom and laboratory value improvement.
- Both patients received standard-of-care treatment for Candida and TMA with unfavorable outcomes.
Conclusions:
- Donor-derived candidemia-associated TMA poses significant challenges in kidney transplantation.
- Current treatment strategies for TMA and candidemia in this setting may be insufficient, necessitating further research into novel therapeutic approaches.
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