*Purpose: Infection in the renal graft hilum may lead to mycotic aneurysm and life threatening bleeding, therefore it often warrants complete excision of the graft. Here, we present a case report of successful treatment of mycotic aneurysm with excision of the renal and iliac arteries, which allowed for salvage of the renal graft.

*Methods: 70 year old male with ESRD, T2DM, on Clopidogrel for CAD underwent a kidney transplantation with basiliximab induction. His postoperative course was complicated by bleeding at the renal artery anastomosis necessitating surgical repair. Despite drainage, he developed infection with Klebsiella Pneumoniae in the retroperitoneal space treated with intravenous antibiotics. A few weeks later, he underwent emergent surgical revision of the renal artery due to acute bleeding. Ten days later, bleeding re-occurred secondary to mycotic aneurysm. Therefore, the renal artery and segment of iliac artery were excised and reconstructed with cadaver Y graft in attempt to salvage the graft. Boari flap technique was utilized to re-anastomose ureter to the bladder. He developed a urinary leak necessitating full diversion with temporary nephrostomy, surgical drain and ureteral stent for several weeks. Klebsiella Penumoniae infection was confirmed in the excised artery.

*Results: The patient recovered without sequalae. 14 months post transplant, the graft function remained stable with a serum creatinine of 1.3mg/ml.

*Conclusions: Infection in the renal graft hilum may lead to mycotic aneurysm. The kidney graft may be successfully salvaged with segmental excision of the renal and iliac arteries

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