Abstract

Background: Vascular complications following kidney transplantation can lead to graft loss. Here, we present two cases of extra renal mycotic pseudo-aneurysm occurring after kidney transplantation.

Methods: Case 1 involved a 54-year-old man who developed a pseudo-aneurysm 60 days post-transplantation, while Case 2 was a 48-year-old woman diagnosed with a pseudo-aneurysm 5 months post-transplantation.

Results: In Case 1, the patient had undergone a deceased-donor kidney transplant with an end-to-side external iliac arterial anastomosis. Eight days after transplantation, reconstruction was performed due to rupture and severe bleeding. At 60 days post-transplantation, the patient presented with high serum creatinine levels, and Doppler ultrasonography revealed a pseudo-aneurysm at the arterial graft anastomosis along with post-anastomotic renal artery stenosis. Treatment included surgical excision of the pseudo-aneurysm, vascular reconstruction, and fluconazole therapy, with mycologic culture confirming Candida albicans. Case 2 experienced non-disabling intermittent claudication at 5 months post-transplantation, and a pseudo-aneurysm was later detected on Doppler ultrasonography and computed tomographic angiography. Treatment involved renal artery thrombectomy and common iliac bypass to the renal artery hilum using reversed ipsilateral long saphenous vein. Operative samples also revealed C. albicans, and fluconazole therapy was initiated. Both patients had favourable outcomes, with preservation of the kidney allografts.

Conclusions: Extrarenal mycotic pseudo-aneurysms following kidney transplantation warrant early detection and intervention. Preservation of the kidney graft can be achieved through surgical management and antifungal therapy.