A Case Series of Ruptured Fungal Mycotic Pseudoaneurysms in Renal Transplant Patients

Area of Science:

• Transplantation
• Vascular Surgery
• Infectious Diseases

Background:

• Mycotic pseudoaneurysms (MPs) are infrequent complications in renal transplant patients.
• Rupture of MPs is an even rarer, life-threatening event.

Purpose of the Study:

• To present clinical symptoms, surgical techniques, and outcomes for four renal transplant patients with MPs presenting with acute bleeding.
• To highlight the diagnostic and management challenges of MPs in immunocompromised hosts.

Main Methods:

• Case series of four renal transplant patients with MPs presenting with acute hemorrhage within 3 weeks post-transplant.
• Review of immunosuppression regimens (rabbit anti-thymocyte globulin, steroids, mycophenolate sodium, tacrolimus) and antifungal prophylaxis (valganciclovir, clotrimazole, sulfamethoxazole-trimethoprim).
• Description of hemorrhage control techniques, including endovascular balloon occlusion, open arterial resection, extra-anatomic bypass, and patch repair.

Main Results:

• All four patients developed Candida infections at the transplant site despite antifungal prophylaxis.
• Hemorrhage originated from the iliac or transplant renal artery.
• Surgical management varied, resulting in one salvaged allograft and three nephrectomies.

Conclusions:

• Mycotic pseudoaneurysms in immunocompromised transplant patients may present with acute bleeding without overt infectious symptoms.
• Early consideration of infection is crucial in acutely bleeding transplant recipients.
• Both open and endovascular approaches are viable for hemorrhage control, with careful consideration of prosthetic infection risk.