Salvage of a kidney transplant with a mycotic extrarenal pseudoaneursym using donor vessels

Abstract

A 63-year-old male developed a mycotic pseudoaneurysm (MPA) two months after a renal transplant at the anastomotic site. He presented with uncontrolled hypertension and elevated creatinine. The pseudoaneurysm occurred at the anastomosis between the two donor renal arteries and the left external iliac artery. We describe a unique surgical reconstruction where the MPA was resected and the vasculature was reconstructed using deceased donor vessels. A deceased donor common iliac artery including superior gluteal and inferior gluteal branches were used as a jump graft from the contralateral common iliac artery to the two transplanted renal arteries. The external iliac artery was repaired with an interposition bypass using deceased donor iliac vein. The patient received 8 weeks of antifungal therapy after the specimen grew candida albicans. Post-operatively, the patient had an acute kidney injury requiring dialysis, but after two months of dialysis, his renal function returned to normal and he remains dialysis-free.