Abstract: FR-PO776
A Rare Cause of Early Graft Failure: Mycotic Aneurysm
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Faruqui, Adnan, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Sharfuddin, Asif A., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Adebiyi, Oluwafisayo O., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Yaqub, Muhammad S., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Jan, Muhammad Yahya, Indiana University School of Medicine, Indianapolis, Indiana, United States
Introduction
Pseudoaneurysm of the kidney artery is a rare complication, seen in <1% of transplant recipients, generally secondary to infectious causes and at the anastomotic site(1). Kidney allograft artery thrombosis is also a rare complication similarly seen in <1% of transplant recipients. Mycotic pseudoaneurysms can present variably from being asymptomatic to fever, abdominal pain, pulsatile expansile mass, and hemorrhagic shock from rupture (2, 3). We present a case of acute allograft dysfunction in a kidney transplant patient caused by mycotic pseudo-aneurysm of the transplanted renal artery(TRA) complicated by thrombosis leading to allograft nephrectomy.
Case Description
A 40-year-old male with a history of ESKD status post deceased donor kidney transplant presented for allograft biopsy for AKI and worsening proteinuria (2.27 g/g from 0.67 g/g). Pre-Biopsy kidney ultrasound showed a new pseudoaneurysm of TRA. He underwent urgent surgical exploration and a cadaveric iliac bypass to the renal artery was done. Subsequently, to reduce the chances of pseudoaneurysm rupture given its friability, interventional radiology was consulted for a covered stent in the aneurysm. Pre-procedure angiogram showed thrombosed transplant renal artery graft, occlusion of the right external iliac and bypass, and transplant nephrectomy was performed. The infected pseudoaneurysm led to disruption of flow to the TRA leading to thrombosis Surgical pathology of the allograft kidney showed organizing thrombi in the main renal artery and segmental branch, acute tubular damage. Clinically the patient remained afebrile, infectious disease workup including blood and urine cultures were negative, Culture of the thrombosed pseudoaneurysm grew Staphylococcus hominis which was treated with IV antibiotics.
Discussion
Renal artery thrombosis and renal artery pseudoaneurysm are themselves rare complications seen in kidney transplant recipients, here we highlight a rare case of pseudoaneurysm contributing to thrombosis, which may further demonstrate urgency in the treatment of pseudoaneurysm.