Contents lists available at ScienceDirect Medical Mycology Case Reports journal homepage: www.elsevier.com/locate/mmcr Donor-derived invasive aspergillosis after kidney transplant Maricela Valerio a,b , Marina Machado a,b,d, ⁎ , Santiago Cedeño c , Maria Luisa Rodríguez c , Fernando Anaya c , Antonio Vena a,b , Jesús Guinea a,b,d,e , Pilar Escribano a,b,d , Emilio Bouza a,b,d,e , Patricia Muñoz a,b,d,e a Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain b Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain c Nephrology Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain d Medicine Department, School of Medicine, Universidad Complutense de Madrid, Pza, Ramón y Cajal, s/n. Ciudad Universitaria, 28040 Madrid, Spain e CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain ARTICLE INFO Keywords: Invasive fungal infections Invasive aspergillosis Solid organ transplant Donor-derived infections Kidney transplant ABSTRACT The risk of transmission of infectious diseases from allograft to recipient is well known. Viruses and bacteria are the most frequent causes of transmissible infections. Donor-derived invasive aspergillosis is rare and occurred under particular circumstances. We report 2 cases of kidney transplant recipients who acquired aspergillosis from a single donor. 1. Introduction The risk of transmission of infectious diseases from allograft to re- cipient is well known, although nowadays uncommon [1]. Viruses and bacteria are the most frequent causes of transmissible infections, with fewer than 25% of donor-derived infections due to fungi [2], mostly Candida spp. [3]. Cases of donor-derived invasive aspergillosis (IA) in transplant pa- tients are unusual [4,5]. Here we report 2 cases of kidney transplant recipients who acquired aspergillosis from a single donor. 2. Case 2.1. Donor The grafts came from a 50-year-old man with a history of alcoholic cirrhosis, several episodes of spontaneous bacterial peritonitis requiring antimicrobial treatment, and a recent admission due to acute alcoholic hepatitis that was treated with high-dose corticosteroids. Fifteen days after discharge he was readmitted with acute liver failure that again required corticosteroids and a relapse of C. difficile infection. On day 7 after admission, he presented with fever and an acute neurologic event requiring ICU admission and intubation. A CT scan demonstrated bi- lateral intraparenchymal hematomas with uncal herniation and new bilateral lung infiltrates. Bronchoalveolar lavage (BAL) culture revealed extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae that was treated with meropenem. The patient died on his fifth day at ICU. Death was attributed to a cerebral hemorrhage resulting from severe liver failure with massive bronchoaspiration. His potential as a kidney donor was based on a renal ultrasound that showed a simple cyst in the cortex of the left kidney (1.3 cm) and a Doppler ultrasound image that revealed adequate vascular flow in both kidneys. Accordingly, the transplant committee accepted his kidneys for transplant. His liver and heart were not used as grafts. 2.2. Recipient 1 He was a 56-year-old man who had received a liver transplant (LTx) 15 years earlier, for which he took cyclosporine A (CyA) and myco- phenolate mofetil (MMF). His general progress was good, and his graft function adequate. Three years after the LTx he experienced hepatitis C relapse and was treated with interferon and ribavirin. Since then, the patient has maintained good liver function. He developed end-stage renal disease (ESRD) due to hepatitis C associated–membranoproliferative glomerulonephritis. Residual diur- esis was 100 mL/24 h, and he had been receiving hemodialysis for the past 36 months. He received a kidney transplant from a deceased donor https://doi.org/10.1016/j.mmcr.2018.07.004 Received 14 June 2018; Accepted 10 July 2018 ⁎ Corresponding author at: Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain. E-mail address: marina.machado@salud.madrid.org (M. Machado). Medical Mycology Case Reports 22 (2018) 24–26 Available online 17 July 2018 2211-7539/ © 2018 The Authors. Published by Elsevier B.V. on behalf of International Society for Human and Animal Mycology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/). T