Invasive fungal infections (IFI) are rare, but serious complications of organ transplantation. We report three cases of IFI affecting recipients of living unrelated renal transplants (LURRTX). Methods: All patients above age 14 years who received a LURRTX between 1/1998 and 12/2003 were included. Result: A total of 79 patients underwent a LURRTX. Mean age was 45 years (15-78) with equal male to female ratio. Three (3.8%) patients had IFI.
Patient 1: A 41 year-old male patient developed end stage renal disease (ESRD) secondary to adult polycystic kidney disease. He received a LURRTX in Pakistan, complicated by re-exploration due to a renal artery kink, and an acute rejection episode (AR) treated with OKT3. Two moths later, the allograft was removed and showed invasive mucormycosis. CT scan revealed lesions in the liver, lungs and spleen. A fine needle aspirate of the liver lesions showed mucor. He received amphotericin B and itraconazole. He died 5 months after transplantation.
Patient 2: A 62-year-old male patient, with ESRD secondary to diabetic nephropathy, had a LURRTX in Iran, complicated by an AR episode that was controlled with steroids. Two months later, he developed a left sided body weakness secondary to ring-enhancing lesions on CT-scan. Culture of the brain biopsy grew Ramichloridium mackenziei. He required surgical evacuation and therapy with posaconazole. Forty-eight months after diagnosis, the patient is alive, but with right-sided hemiplegia.
Patient 3: A 48 year-old female with ESRD secondary to diabetic nephropathy, received a LURRTX in the Phillipines. Antithymocyte globulin was used as an induction therapy. Two months later, she developed fever and back ache. CT revealed osteomyelitis with prevertebral abscess at L5. Aspiration of L5 lesion revealed Aspergillus fumigatus. She died 5 months later despite treatment with liposomal amphotericin B and caspofungin. IFI are severe complications of organ transplantation precipitated by immunosuppression. Caution should be paid to recipients of LURRTX treated for acute rejection.