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Li H, Lin YC, Kao CC, Chiang PJ, Chou MH, Ting HK, Jhuo YC, Yang MH, Tsao CW, Meng E, Sun GH, Yu DS, Chang SY, Chen CL, Wu ST. A Novel Hybrid Approach to Manage Mycotic Pseudoaneurysm Post-Renal Transplantation: Successful Graft Preservation. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:521. [PMID: 40142332 PMCID: PMC11943577 DOI: 10.3390/medicina61030521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 03/01/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: Post-transplant anastomotic pseudoaneurysms are a rare but serious complication of renal transplantation, typically requiring graft sacrifice. This case report demonstrates a novel hybrid approach for managing a mycotic pseudoaneurysm while preserving graft function. Case report: A 56-year-old male developed a pseudoaneurysm at the anastomotic site after cadaveric kidney transplantation, presenting with recurrent infections and declining renal function. Imaging confirmed the pseudoaneurysm. A hybrid strategy combining femoral-femoral bypass with a polytetrafluoroethylene graft, percutaneous transluminal angioplasty with stenting, and coil embolization was performed. Results: The intervention successfully isolated the pseudoaneurysm and preserved graft function. Post-procedure, serum creatinine levels improved, stabilizing at 2.3 mg/dL during follow-up. Imaging confirmed no residual flow in the aneurysm, and vascular complications were absent. Conclusions: This report highlights a successful combined surgical and endovascular approach for treating mycotic pseudoaneurysms, preserving graft function and restoring limb blood flow. This strategy offers a promising alternative for managing complex post-transplant complications, though long-term outcomes require further evaluation.
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Affiliation(s)
- Ho Li
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
- Division of Urology, Department of Surgery, Gangshan Branch of Zuoying Armed Forces General Hospital, Kaohsiung 820, Taiwan
| | - Yi-Chang Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chien-Chang Kao
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Pei-Jhang Chiang
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Meng-Han Chou
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Hui-Kung Ting
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Yu-Cing Jhuo
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Ming-Hsin Yang
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Chih-Wei Tsao
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Guang-Huan Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Sun-Yran Chang
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Chin-Li Chen
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (H.L.); (P.-J.C.); (M.-H.C.); (Y.-C.J.); (M.-H.Y.)
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Abstract
PURPOSE OF REVIEW Advances in preservation and transplantation techniques have made renal autotransplantation (RA) a modality that can be utilized in complex renovascular diseases (renal artery aneurysms), high ureteric injuries, chronic kidney pain, as well as conventionally unresectable renal tumours. In the current review, we present the Oxford experience, the only UK commissioned centre to perform RA for complex renal cell cancers, and review the published RA experience from other UK centres. RECENT FINDINGS The evidence and literature generated from the RA experience in the UK are largely limited to case reports. The main indications reported for performing RAs include renovascular disease, ureteral pathology and prophylaxis from radiation. Renal autotransplantation is an option for a highly select group of patients. It has short-term and long-term complication rates comparable to those of other major operations. Extensive preoperative counselling in conjunction with multidisciplinary professionals is of utmost importance for informed decision making.
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Affiliation(s)
- Georgios Vrakas
- Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK.
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
| | - Mark Sullivan
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK
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Bindi M, Ferraresso M, De Simeis ML, Raison N, Clementoni L, Delbue S, Perego M, Favi E. Allograft artery mycotic aneurysm after kidney transplantation: A case report and review of literature. World J Clin Cases 2020; 8:912-921. [PMID: 32190627 PMCID: PMC7062617 DOI: 10.12998/wjcc.v8.i5.912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/08/2020] [Accepted: 02/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Allograft artery mycotic aneurysm (MA) represents a rare but life-threatening complication of kidney transplantation. Graftectomy is widely considered the safest option. Due to the rarity of the disease and the substantial risk of fatal consequences, experience with conservative strategies is limited. To date, only a few reports on surgical repair have been published. We describe a case of true MA successfully managed by aneurysm resection and arterial re-anastomosis. CASE SUMMARY An 18-year-old gentleman, on post-operative day 70 after deceased donor kidney transplantation, presented with malaise, low urinary output, and worsening renal function. Screening organ preservation fluid cultures, collected at the time of surgery, were positive for Candida albicans. Doppler ultrasound and contrast-enhanced computer tomography showed a 4-cm-sized, saccular aneurysm of the iuxta-anastomotic segment of the allograft artery, suspicious for MA. The lesion was wide-necked and extended to the distal bifurcation of the main arterial branch, thus preventing endovascular stenting and embolization. After multidisciplinary discussion, the patient underwent surgical exploration, aneurysm excision, and re-anastomosis between the stump of the allograft artery and the internal iliac artery. The procedure was uneventful. Histology and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida infection. Three years after the operation, the patient is doing very well with excellent allograft function and no signs of recurrent disease. CONCLUSION Surgical repair represents a feasible option in carefully selected patients with allograft artery MA. Anti-fungal prophylaxis is advised when preservation fluid cultures are positive.
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Affiliation(s)
- Marco Bindi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Maria Letizia De Simeis
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Laura Clementoni
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20100, Italy
| | - Marta Perego
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
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Marie Y, Kumar A, Hinchliffe S, Curran S, Brown P, Turner D, Shrestha B. Treatment of transplant renal artery pseudoaneurysm using expandable hydrogel coils: A case report and review of literature. World J Transplant 2018; 8:232-236. [PMID: 30370233 PMCID: PMC6201328 DOI: 10.5500/wjt.v8.i6.232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/28/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023] Open
Abstract
Transplant renal artery (TRA) pseudoaneurysm can result in bleeding, infection, graft dysfunction and graft loss. We report the management of a renal transplant recipient who presented five months after renal transplantation with deterioration of renal function, who was found to have TRA pseudoaneurysm and TRA stenosis. Both were treated radiologically by using expandable hydrogel coils (EHC) in combination with stenting. Improvement in clinical, biochemical and radiological parameters were observed after the intervention. To our knowledge, this is the first report in the transplant literature on the use of EHC for the treatment of a TRA pseudoaneurysm.
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Affiliation(s)
- Yazin Marie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Avneesh Kumar
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Sarah Hinchliffe
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Simon Curran
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Peter Brown
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Douglas Turner
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
| | - Badri Shrestha
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, United Kingdom
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Lin YH, Liao CH, Jiang BJ, Chen TH. Early renal arterial rupture and arterial pseudoaneurysm in graft kidneys from the same deceased donor. Tzu Chi Med J 2018; 30:250-254. [PMID: 30305791 PMCID: PMC6172893 DOI: 10.4103/tcmj.tcmj_180_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 01/09/2023] Open
Abstract
Vascular complications are serious problems after kidney transplantation. An aneurysm or rupture in a graft artery is a rare but potentially devastating complication, which may lead to renal function impairment, graft loss, or even death. In this paper, we present two rare vascular complications in the early postoperative course after renal transplantation from the same deceased donor. In the first case, a 49-year-old woman who had spontaneous graft arterial rupture 13 days after kidney transplantation presented with sudden distension in the right lower abdomen. In the second case, a 56-year-old woman recipient with a graft renal arterial pseudoaneurysm presented with decreased urine output and deteriorating renal function 32 days after transplantation. Immediate surgical repair was performed, and fibrin sealant was applied to strengthen the fragile renal arterial wall. Although the function of both graft kidneys recovered well after surgery, the first graft kidney was removed 2 months later because of repeated fungal and bacterial infections. Aggressive surgical reconstruction may preserve graft kidneys in patients with vascular complications after kidney transplantation, but recovery of the graft condition remains a demanding challenge in renal transplantation.
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Affiliation(s)
- Yu-Hua Lin
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei, Taiwan
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Hou Liao
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Bing-Jun Jiang
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Tzu-Hung Chen
- Department of General Surgery, Cardinal Tien Hospital, New Taipei, Taiwan
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Chung MM, Chan YC, Law Y, Cheng SW. Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature. Int J Nephrol Renovasc Dis 2017; 10:55-60. [PMID: 28260939 PMCID: PMC5325110 DOI: 10.2147/ijnrd.s122725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grew Enterococcus faecium and Pseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yielded P. aeruginosa. Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grew P. aeruginosa, and he was put on imipenem and cilastatin (tienam), colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world’s literature in which a P. aeruginosa infectious anastomotic pseudoaneurysm developed after a renal allograft.
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Affiliation(s)
- Marvin Mt Chung
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yuk Law
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wk Cheng
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Sin HKK, Fung SKS, Tang HL, Cheuk A, Lee W, Yim KF, Poon KY, Wong LY, Cheng HM. Bleeding post-transplantation intrarenal pseudoaneurysms. Int J Organ Transplant Med 2016. [DOI: 10.1016/j.hkjn.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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