TY - JOUR
T1 - Infectious complications of old nonfunctioning arteriovenous grafts in renal transplant recipients
T2 - A case series
AU - Nassar, George M.
AU - Ayus, Juan Carlos
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2002/10
Y1 - 2002/10
N2 - Occult infection of old nonfunctioning arteriovenous grafts (AVGs) is frequent among hemodialysis patients. It is a risk factor for bacteremia and serious AVG-related infection. Immunocompromised patients are at increased risk of dissemination of occult AVG infection. We present a series of five renal transplant recipients who developed acute life-threatening infections that originated in their old nonfunctioning AVGs. Their presenting symptoms were noticeably varied. In two patients, infection of the AVG was characterized by local physical signs of infection around the AVG. In three patients, no physical signs of AVG infection were detected by physical examination. Among these, two presented with bacteremia, and one presented with failure to thrive. Detection of AVG infection in the absence of local signs of infection requires a high index of suspicion. Surgical resection and antimicrobial treatment led to a complete cure in four of these patients. One patient developed recurrent bacterial endocarditis and died. Old nonfunctioning AVGs are potential sources of serious infection in renal transplant recipients. Renal transplant recipients with old nonfunctioning AVGs who present with unexplained bacteremia, fever of unknown origin, or failure to thrive should be investigated for occult AVG infection. Screening for occult infection of the old nonfunctioning AVG may be considered before kidney transplantation, especially if the candidate gives a history of previous bacteremia or fever of unknown origin.
AB - Occult infection of old nonfunctioning arteriovenous grafts (AVGs) is frequent among hemodialysis patients. It is a risk factor for bacteremia and serious AVG-related infection. Immunocompromised patients are at increased risk of dissemination of occult AVG infection. We present a series of five renal transplant recipients who developed acute life-threatening infections that originated in their old nonfunctioning AVGs. Their presenting symptoms were noticeably varied. In two patients, infection of the AVG was characterized by local physical signs of infection around the AVG. In three patients, no physical signs of AVG infection were detected by physical examination. Among these, two presented with bacteremia, and one presented with failure to thrive. Detection of AVG infection in the absence of local signs of infection requires a high index of suspicion. Surgical resection and antimicrobial treatment led to a complete cure in four of these patients. One patient developed recurrent bacterial endocarditis and died. Old nonfunctioning AVGs are potential sources of serious infection in renal transplant recipients. Renal transplant recipients with old nonfunctioning AVGs who present with unexplained bacteremia, fever of unknown origin, or failure to thrive should be investigated for occult AVG infection. Screening for occult infection of the old nonfunctioning AVG may be considered before kidney transplantation, especially if the candidate gives a history of previous bacteremia or fever of unknown origin.
KW - Arteriovenous graft (AVG)
KW - Infection
KW - Kidney transplantation
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U2 - 10.1053/ajkd.2002.35696
DO - 10.1053/ajkd.2002.35696
M3 - Article
C2 - 12324920
AN - SCOPUS:0036789234
SN - 0272-6386
VL - 40
SP - 832
EP - 836
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -