*Purpose: Only few cases of infectious pseudoaneurysm of the transplant renal artery caused by Pseudomonas aeruginosa are reported in literature. Here we describe three such cases presenting with transplant renal artery rupture.

*Methods: Cases of invasive infection with vascular complications that occurred at our transplant center since inception of our program in November 2012 through October 2021 are reviewed. Additionally, we report the course of a patient from another transplant center that received a kidney transplant from the same donor as one of our recipients.

*Results: Of 751 kidney transplants performed during this period, two patients (0.26%) developed infectious pseudoaneurysm of transplant renal artery. The first patient is a 54-year-old female with end stage renal disease (ESRD) due to polycystic kidney disease that received a pediatric en bloc kidney transplant. Four weeks following transplant, she presented to the hospital with fever, hypotension and hemoglobin of 5.1 g/dl. Exploratory laparotomy revealed pseudoaneurysm with rupture of anastomosis of donor aorta to recipient iliac artery requiring transplant nephrectomy. Urine, blood and surgical cultures grew Pseudomonas aeruginosa. The second patient is a 52-year-old female with ESRD secondary to diabetes mellitus that received a kidney transplant and presented to hospital on post-transplant day nine with abdominal pain and hemoglobin of 5.7 g/dl. Exploratory laparotomy was performed for evacuation of the hematoma but no obvious source of bleed was found. Operative cultures were negative. On post-transplant day 15, she presented back to the hospital with fever and hemoglobin of 2.6 g/dl. Emergent re-exploration revealed complete rupture of the transplant renal artery at hilum requiring transplant nephrectomy. Blood and surgical cultures grew Pseudomonas aeruginosa. Our enquiry revealed that a transplant recipient at another center who received kidney transplant from the same donor as our second patient presented to the hospital a week after transplant with profuse bleeding from the transplant renal artery and died. A genomic sequence analysis of Pseudomonas isolates from both patients was consistent with a donor derived infection. Later we were notified by Organ Procurement Organization about the leakage and recall of cassettes used to pump this donor’s kidneys.

*Conclusions: Infectious pseudoaneurysm due to Pseudomonas aeruginosa is a rare but devastating complication of kidney transplant that could lead to allograft loss and patient death. Most cases are not diagnosed until dehiscence of the involved artery and/or vascular anastomosis. Possibility of contaminated organ preservation solution or donor derived infection should be considered.

« Back to 2022 American Transplant Congress