Rupture of mycotic aneurysm complicating deceased donor renal transplantation: a dual case report

BACKGROUND: Mycotic aneurysms of the transplant renal artery (TRA) are rare but life-threatening complications following renal transplantation, often resulting in graft loss and high mortality. Prompt recognition and timely management are essential to prevent catastrophic haemorrhage and improve patient outcomes. CASE PRESENTATION: We report two cases of ruptured mycotic aneurysms in cadaveric renal allografts. Both patients were on maintenance haemodialysis and underwent deceased donor kidney transplantation. In the first case, the patient presented two weeks postoperatively with haemodynamic instability and intra-abdominal bleeding. Imaging revealed active contrast extravasation near the arterial anastomosis. Emergency exploration revealed a ruptured mycotic aneurysm, necessitating graft nephrectomy; despite antifungal therapy, the patient succumbed to rebleeding. In the second case, the patient presented with fever and hypotension ten days post-transplant. Imaging revealed absent graft perfusion with peri-graft collection. Graft nephrectomy was performed, and histopathology confirmed fungal arteritis. The patient responded to antifungal therapy and recovered, albeit with graft loss. CONCLUSION: Ruptured mycotic aneurysms of the transplant renal artery (TRA) can have catastrophic outcomes. Despite early diagnosis and initiation of antifungal therapy, graft nephrectomy may be unavoidable in cases with rupture and hemodynamic compromise. Emphasis should be placed on strict aseptic protocols during organ retrieval and handling. Routine culture of preservation fluid may aid in early detection of fungal contamination, enabling timely intervention and potential graft salvage.