临床肾移植DCD供者来源的白色念珠菌感染防治经验体会

Prevention and treatment of the DCD donor-derived infection of Candida albicans in renal transplant recipients

目的探讨肾移植DCD供者来源的白色念珠菌感染的临床特点和防治策略。方法回顾性分析2015年1月-2016年12月共8例DCD供肾保存液白色念珠菌培养阳性的肾移植受者手术后的临床资料。结果 8例患者中,1例受者未进行预防性抗真菌药物治疗,在术后2周因突发移植肾动脉破裂出血而行移植肾切除,1例受者采用治疗剂量的米卡芬净预防10天,仍然在术后3周因移植肾动脉破裂出血而切除移植肾。其余6例受者在保存液培养回报为白色念珠菌后,结合移植肾周引流液的定期培养监测,5例采用足量足疗程的米卡芬净进行防治,未出现不良后果;1例采用两性霉素B脂质体序贯伏立康唑防治,未出现真菌感染表现。结论对DCD供肾保存液培养为白色念珠菌的受者,建立有效的监控和防治体系,对于避免真菌感染导致的移植肾严重后果十分必要。

Objective To investigate the clinical characteristics and prevention strategies of donor-derived candida albicans infection in transplant patients with renal grafts from donation after citizen＇s death（DCD）. Methods The clinical data of 8 patients, who underwent kidney transplantation between January 2015 and December 2016 with candida albicans detected in their grafts preservation fluids, were retrospectively analyzed. Results One patient was not treated with prophylactic antifungal agents and had a nephrectomy at 2 weeks after renal transplantation due to rupture of the renal artery of graft. The recipient of the contralateral kidney from the same donor was treated with micafungin for 10 days. Still, it was removed 3 weeks after transplantation because of artery anastomotic rupture. After that, routine fungal cultures in peripheral drainage of renal allografts were conducted. Donor derived candida albicans infections were successfully prevent in 5 recipients by micafungin with adequate dosage and time of therapy. This infection was also effectively prevented in 1 patient by amphotericin B liposome followed with voriconazole. Conclusion It is necessary to establish an effective surveillance and control process for recipients whose graft preservation fluid contaminated by candida albicansto avoid serious consequences of grafts caused by fungal infection.