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Abstract: SA-PO1121

Renal Aspergillosis After Liver Transplant

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Kumar, Rahul, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Mehdi, Ali, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Abu Hweij, Roulan, Cleveland Clinic Foundation, Cleveland, Ohio, United States
  • Fatica, Richard A., Cleveland Clinic Foundation, Cleveland, Ohio, United States

Group or Team Name

  • Cleveland Clinic Foundation, Ohio
Introduction

Renal aspergillosis is a rare life-threatening disorder in liver transplant recipients. Only 3 cases have been reported in the literature to date. This dreaded complication usually occurs within 90 days of transplant but late onset has been reported. We hereby present a case of renal aspergillosis occurring one year after liver transplantation.

Case Description

A 40-year-old white female presented with right-sided abdominal pain and vomiting for two weeks. Her history was significant for cryptogenic cirrhosis for which she had a living donor liver transplant one year prior. Two months before admission, she was found to have a spontaneous right renal subcapsular hematoma and acute kidney injury with previously normal eGFR, which was managed conservatively. Immunosuppression on admission included tacrolimus and MMF. Work up showed WBC 30000/uL and a creatinine of 3.5 mg/dl. CT scan showed expansion of the right renal subcapsular hematoma, measuring 10 x 9.6 x 7.6 cm and compressing the renal parenchyma. She was urgently taken for exploration and was found to have a large abscess with nonviable kidney. As such, evacuation and nephrectomy was performed. Pathology showed acute pyelonephritis with abscess, necrosis, and necrotizing granulomas containing fungal organisms consistent with Aspergillus species. She was treated with antifungal therapy for three months. The kidney function continued to deteriorate following many subsequent ischemic insults. The patient eventually required dialysis.

Discussion

Renal aspergillosis in liver transplant recipients carries significant morbidity and mortality. Risk factor includes severe immunosuppression, kidney failure, prior urological procedures, CMV or HHV-6 infection, and fulminant hepatic failure as a cause for transplant. Although renal aspergillosis is uncommon, a high degree of suspicion is required in transplant recipients as early detection and treatment can be life-saving.