Kidney Week

Abstract: SA-PO1148

A Case of Donor-Derived Candida dubliniensis Infection Associated with Delayed Graft Function

Session Information

• Transplantation: Clinical - Infectious Diseases
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Rademacher, Emily, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Emily Rademacher, MD

• Sisel, Emily, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Emily Sisel, MD

• Xu, Eric Jia Yi, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Eric Jia Yi Xu, MD

• Rosen, Seymour, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Seymour Rosen, MD

• Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Bhavna Chopra, MD, FASN

• Le-Mahajan, Audrey Han Ngoc, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Audrey Han Ngoc Le-Mahajan, MD, MSc

• Aala, Amtul, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

Amtul Aala, MD

Introduction

Donor-derived fungal infections constitute a rare but significant complication in kidney transplant (KT) recipients. This population may exhibit more subtle signs of infection due to immunosuppression.

Case Description

We present a case of a 50-year-old KT recipient whose course was complicated by delayed graft function and anuria. Initial biopsy at 1 month was concerning for acute cellular rejection that was treated with steroids. He was readmitted with abdominal pain and urinary retention. His urine culture grew yeast (<100,000 CFU, not speciated) that was not initially treated. He remained anuric and underwent repeat biopsy at 8 weeks that showed neutrophilic casts (Figure 1A). At this time, his repeat urine culture was negative. At 2.5 months after transplant, he represented with fever and graft tenderness. His work up revealed an elevated serum beta D-glucan (>500 pg/mL) and a urine culture that grew 2,000 CFU/ml yeast. He was initiated on fluconazole. At that time, review of the donor’s chart revealed C. dubliniensis isolated in bronchial wash cultures (absent in blood and urine cultures). The recipient’s urine culture speciation also identified C. dubliniensis (fluconazole MIC 0.25mcg/ml). This prompted inquiry to the organ procurement organization (OPO), revealing that the mate kidney recipient also developed C. dubliniensis pyelonephritis. Review of the previous biopsy confirmed a negative gram stain, but Grocott’s Methenamine Silver stains were done and showed degenerating yeast forms (Figure 1B). After starting fluconazole, the recipient started to make 300 cc of urine daily, though he remains on dialysis.

Discussion

This is a rare case of donor-derived C. dubliniensis infection in a KT recipient without disseminated fungemia in the donor. It highlights the challenges posed by interpreting the relevance of donor cultures, low-level yeast isolation in urine cultures, and nonspecific biopsy changes. Inquiries to the OPO can identify donor-derived infections and inform other organ recipients. Early recognition and prompt antifungal therapy may facilitate graft recovery.