Renal Mucormycosis: A Rare and Potentially Lethal Complication of Kidney Transplantation
Identifieur interne : 002009 ( Pmc/Checkpoint ); précédent : 002008; suivant : 002010Renal Mucormycosis: A Rare and Potentially Lethal Complication of Kidney Transplantation
Auteurs : Sreyram Kuy [États-Unis] ; Chun He [États-Unis] ; David C. Cronin [États-Unis]Source :
- Case Reports in Transplantation [ 2090-6943 ] ; 2013.
Abstract
Renal mucormycosis is a rare and potentially lethal complication of kidney transplantation. We describe two cases of renal mucormycosis following deceased donor kidney transplantation. This is the second report of renal mucormycosis following kidney transplantation in the United States, and the first case of renal mucormycosis infection presumed to be of recipient origin. Case A had an early presentation of mucormycosis isolated to the kidney allograft. He had an unexpected rise in serum creatinine and leukocytosis necessitating allograft biopsy which showed mucormycosis. He underwent transplant nephrectomy on posttransplant day 11, was treated with amphotericin B, and discharged home on posttransplant day 22. Case B had a late presentation of renal mucormycosis, preceded by a cutaneous manifestation. One year after kidney transplantation he had a nonhealing knee ulcer which on biopsy showed cutaneous mucormycosis. Treatment included aggressive debridement and amphotericin B. Allograft biopsy showed mucormycosis, necessitating transplant nephrectomy. He was discharged to a rehabilitation facility and died from noninfectious causes. Review of the published literature of renal mucormycosis cases following kidney transplantation reveals a mortality rate of more than 50%. The key to successful outcome is early recognition, prompt institution of surgical debridement of all infected tissue, and appropriate antifungal therapy.
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DOI: 10.1155/2013/915423
PubMed: 24251062
PubMed Central: 3819800
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Renal Mucormycosis: A Rare and Potentially Lethal Complication of Kidney Transplantation</title><author><name sortKey="Kuy, Sreyram" sort="Kuy, Sreyram" uniqKey="Kuy S" first="Sreyram" last="Kuy">Sreyram Kuy</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226</wicri:regionArea><wicri:noRegion>WI 53226</wicri:noRegion></affiliation></author><author><name sortKey="He, Chun" sort="He, Chun" uniqKey="He C" first="Chun" last="He">Chun He</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Cronin, David C" sort="Cronin, David C" uniqKey="Cronin D" first="David C." last="Cronin">David C. Cronin</name><affiliation wicri:level="1"><nlm:aff id="I3">Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24251062</idno><idno type="pmc">3819800</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819800</idno><idno type="RBID">PMC:3819800</idno><idno type="doi">10.1155/2013/915423</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">003D26</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003D26</idno><idno type="wicri:Area/Pmc/Curation">003D25</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003D25</idno><idno type="wicri:Area/Pmc/Checkpoint">002009</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002009</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Renal Mucormycosis: A Rare and Potentially Lethal Complication of Kidney Transplantation</title><author><name sortKey="Kuy, Sreyram" sort="Kuy, Sreyram" uniqKey="Kuy S" first="Sreyram" last="Kuy">Sreyram Kuy</name><affiliation wicri:level="1"><nlm:aff id="I1">Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226</wicri:regionArea><wicri:noRegion>WI 53226</wicri:noRegion></affiliation></author><author><name sortKey="He, Chun" sort="He, Chun" uniqKey="He C" first="Chun" last="He">Chun He</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pathology, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Cronin, David C" sort="Cronin, David C" uniqKey="Cronin D" first="David C." last="Cronin">David C. Cronin</name><affiliation wicri:level="1"><nlm:aff id="I3">Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author></analytic><series><title level="j">Case Reports in Transplantation</title><idno type="ISSN">2090-6943</idno><idno type="eISSN">2090-6951</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Renal mucormycosis is a rare and potentially lethal complication of kidney transplantation. We describe two cases of renal mucormycosis following deceased donor kidney transplantation. This is the second report of renal mucormycosis following kidney transplantation in the United States, and the first case of renal mucormycosis infection presumed to be of recipient origin. Case A had an early presentation of mucormycosis isolated to the kidney allograft. He had an unexpected rise in serum creatinine and leukocytosis necessitating allograft biopsy which showed mucormycosis. He underwent transplant nephrectomy on posttransplant day 11, was treated with amphotericin B, and discharged home on posttransplant day 22. Case B had a late presentation of renal mucormycosis, preceded by a cutaneous manifestation. One year after kidney transplantation he had a nonhealing knee ulcer which on biopsy showed cutaneous mucormycosis. Treatment included aggressive debridement and amphotericin B. Allograft biopsy showed mucormycosis, necessitating transplant nephrectomy. He was discharged to a rehabilitation facility and died from noninfectious causes. Review of the published literature of renal mucormycosis cases following kidney transplantation reveals a mortality rate of more than 50%. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Transplant</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Transplant</journal-id><journal-id journal-id-type="publisher-id">CRIM.TRANSPLANTATION</journal-id><journal-title-group><journal-title>Case Reports in Transplantation</journal-title></journal-title-group><issn pub-type="ppub">2090-6943</issn><issn pub-type="epub">2090-6951</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24251062</article-id><article-id pub-id-type="pmc">3819800</article-id><article-id pub-id-type="doi">10.1155/2013/915423</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Renal Mucormycosis: A Rare and Potentially Lethal Complication of Kidney Transplantation</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-4023-1762</contrib-id><name><surname>Kuy</surname><given-names>SreyRam</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>He</surname><given-names>Chun</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cronin</surname><given-names>David C.</given-names><suffix>II</suffix></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA</aff><aff id="I2"><sup>2</sup>Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA</aff><aff id="I3"><sup>3</sup>Division of Transplantation, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA</aff><author-notes><corresp id="cor1">*SreyRam Kuy: <email>srkuy@mcw.edu</email></corresp><fn fn-type="other"><p>Academic Editors: P. A. Andrews, G. Forrest, and M. Klinger</p></fn></author-notes><pub-date pub-type="ppub"><year>2013</year></pub-date><pub-date pub-type="epub"><day>22</day><month>10</month><year>2013</year></pub-date><volume>2013</volume><elocation-id>915423</elocation-id><history><date date-type="received"><day>9</day><month>8</month><year>2013</year></date><date date-type="accepted"><day>8</day><month>9</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013 SreyRam Kuy et al.</copyright-statement><copyright-year>2013</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Renal mucormycosis is a rare and potentially lethal complication of kidney transplantation. We describe two cases of renal mucormycosis following deceased donor kidney transplantation. This is the second report of renal mucormycosis following kidney transplantation in the United States, and the first case of renal mucormycosis infection presumed to be of recipient origin. Case A had an early presentation of mucormycosis isolated to the kidney allograft. He had an unexpected rise in serum creatinine and leukocytosis necessitating allograft biopsy which showed mucormycosis. He underwent transplant nephrectomy on posttransplant day 11, was treated with amphotericin B, and discharged home on posttransplant day 22. Case B had a late presentation of renal mucormycosis, preceded by a cutaneous manifestation. One year after kidney transplantation he had a nonhealing knee ulcer which on biopsy showed cutaneous mucormycosis. Treatment included aggressive debridement and amphotericin B. Allograft biopsy showed mucormycosis, necessitating transplant nephrectomy. He was discharged to a rehabilitation facility and died from noninfectious causes. Review of the published literature of renal mucormycosis cases following kidney transplantation reveals a mortality rate of more than 50%. The key to successful outcome is early recognition, prompt institution of surgical debridement of all infected tissue, and appropriate antifungal therapy.</p></abstract></article-meta></front><floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Case A renal allograft histology. Figures <xref ref-type="fig" rid="fig1">1(a)</xref> and <xref ref-type="fig" rid="fig1">1(b)</xref> show renal allograft biopsy indicating broad, pleomorphic, and thin walled fungal small fragments and hyphae with right angle branching and mucoid feature in presence of tissue necrosis consistent with mucormycosis in hematoxylin and eosin stain (a) and Gomori's methenamine silver stain (b). Explanted allograft kidney demonstrates diffuse and invasive mucormycosis predominantly involving the medulla noted by low magnification in (c) and high magnification in (d) on H&E stain; no mucormycetes invasion of renal artery (e) and vein (f); mucormycetes invasion in proximal portion of ureter indicative of donor ureter (g), and no mucormycetes invasion in distal portion of ureter indicative of recipient ureter (h).</p></caption><graphic xlink:href="CRIM.TRANSPLANTATION2013-915423.001"></graphic></fig><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Case B renal allograft biopsy. Intratubular small fragments and hyphae of mucormycetes (by arrows) without extratubular invasion are noted by low magnification (a) and high magnification (b) on H&E staining sections. </p></caption><graphic xlink:href="CRIM.TRANSPLANTATION2013-915423.002"></graphic></fig><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Cases of renal mucormycosis following kidney transplantation.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Case report</th><th align="center" rowspan="1" colspan="1">R/D age</th><th align="center" rowspan="1" colspan="1">R/D sex</th><th align="center" rowspan="1" colspan="1">Donor type</th><th align="center" rowspan="1" colspan="1">Donor cause of death</th><th align="center" rowspan="1" colspan="1">Recipient disease</th><th align="center" rowspan="1" colspan="1">Time to transplant nephrectomy (PT)</th><th align="center" rowspan="1" colspan="1">Induction agent</th><th align="center" rowspan="1" colspan="1">Systemic therapy</th><th align="center" rowspan="1" colspan="1">Geographic location</th><th align="center" rowspan="1" colspan="1">Speciation</th><th align="center" rowspan="1" colspan="1">Outcome (PT)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">S. Kuy et al.</td><td align="center" rowspan="1" colspan="1">36/43</td><td align="center" rowspan="1" colspan="1">M/F</td><td align="center" rowspan="1" colspan="1">SCD</td><td align="center" rowspan="1" colspan="1">Intracranial hemorrhage</td><td align="center" rowspan="1" colspan="1">Hemolytic uremic syndrome</td><td align="center" rowspan="1" colspan="1">11 days</td><td align="center" rowspan="1" colspan="1">Thymoglobulin, Solu Medrol</td><td align="center" rowspan="1" colspan="1">Amphotericin B</td><td align="center" rowspan="1" colspan="1">US</td><td align="center" rowspan="1" colspan="1"><italic>Rhizomucor </italic></td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">S. Kuy et al.</td><td align="center" rowspan="1" colspan="1">54/61</td><td align="center" rowspan="1" colspan="1">M/F</td><td align="center" rowspan="1" colspan="1">DCD ECD</td><td align="center" rowspan="1" colspan="1">Stroke</td><td align="center" rowspan="1" colspan="1">Diabetes mellitus, hypertension</td><td align="center" rowspan="1" colspan="1">13 months</td><td align="center" rowspan="1" colspan="1">Thymoglobulin, Solu Medrol</td><td align="center" rowspan="1" colspan="1">Amphotericin B</td><td align="center" rowspan="1" colspan="1">US</td><td align="center" rowspan="1" colspan="1"><italic>Rhizomucor </italic></td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Alexander et al. [<xref rid="B9" ref-type="bibr">9</xref>]</td><td align="center" rowspan="1" colspan="1">61/17</td><td align="center" rowspan="1" colspan="1">M/F</td><td align="center" rowspan="1" colspan="1">DCD</td><td align="center" rowspan="1" colspan="1">MVC, drowning </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">9 days</td><td align="center" rowspan="1" colspan="1">Thymoglobulin, Solu Medrol</td><td align="center" rowspan="1" colspan="1">Amphotericin B</td><td align="center" rowspan="1" colspan="1">US</td><td align="center" rowspan="1" colspan="1"><italic>Apophysomyces elegans </italic></td><td align="center" rowspan="1" colspan="1">Died <break></break>(12 days)</td></tr><tr><td align="left" rowspan="1" colspan="1">Alexander et al. [<xref rid="B9" ref-type="bibr">9</xref>]</td><td align="center" rowspan="1" colspan="1">31/17</td><td align="center" rowspan="1" colspan="1">F/F</td><td align="center" rowspan="1" colspan="1">DCD</td><td align="center" rowspan="1" colspan="1">MVC, drowning </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">10 days</td><td align="center" rowspan="1" colspan="1">Thymoglobulin, Solu Medrol</td><td align="center" rowspan="1" colspan="1">Amphotericin B</td><td align="center" rowspan="1" colspan="1">US</td><td align="center" rowspan="1" colspan="1"><italic>Apophysomyces elegans </italic></td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Mitwalli et al. [<xref rid="B10" ref-type="bibr">10</xref>]</td><td align="center" rowspan="1" colspan="1">18/—</td><td align="center" rowspan="1" colspan="1">F/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Polycystic kidney disease</td><td align="center" rowspan="1" colspan="1">1 month </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Amphotericin B </td><td align="center" rowspan="1" colspan="1">India </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Nampoory et al. [<xref rid="B11" ref-type="bibr">11</xref>]</td><td align="center" rowspan="1" colspan="1">59/—</td><td align="center" rowspan="1" colspan="1">F/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">1 month </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Kuwait </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Died <break></break>(3 months)</td></tr><tr><td align="left" rowspan="1" colspan="1">Stas et al. [<xref rid="B12" ref-type="bibr">12</xref>]</td><td align="center" rowspan="1" colspan="1">51/—</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Henoch-Schonlein nephritis</td><td align="center" rowspan="1" colspan="1">2.5 months </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">India</td><td align="center" rowspan="1" colspan="1"><italic>Absidia corymbifera </italic></td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Chkhotua et al. [<xref rid="B13" ref-type="bibr">13</xref>]</td><td align="center" rowspan="1" colspan="1">42/—</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Glomerulonephritis</td><td align="center" rowspan="1" colspan="1">1.5 months </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Egypt</td><td align="center" rowspan="1" colspan="1"><italic>Mucorales </italic></td><td align="center" rowspan="1" colspan="1">Died <break></break>(1.5 months)</td></tr><tr><td align="left" rowspan="1" colspan="1">Nalmas et al. [<xref rid="B14" ref-type="bibr">14</xref>]</td><td align="center" rowspan="1" colspan="1">62</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">3 weeks </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Pakistan</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Armaly et al. [<xref rid="B15" ref-type="bibr">15</xref>]</td><td align="center" rowspan="1" colspan="1">42/—</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Poststreptococcal glomerulonephritis</td><td align="center" rowspan="1" colspan="1">1 month </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Egypt </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Died <break></break>(1.5 months)</td></tr><tr><td align="left" rowspan="1" colspan="1">Armaly et al. [<xref rid="B15" ref-type="bibr">15</xref>]</td><td align="center" rowspan="1" colspan="1">52/—</td><td align="center" rowspan="1" colspan="1">F/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Diabetes mellitus</td><td align="center" rowspan="1" colspan="1">1 month </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Egypt </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Godara et al. [<xref rid="B16" ref-type="bibr">16</xref>]</td><td align="center" rowspan="1" colspan="1">42/—</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">1 month</td><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">Amphotericin B</td><td align="center" rowspan="1" colspan="1">India </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Died <break></break>(1 month)</td></tr><tr><td align="left" rowspan="1" colspan="1">Sajiv et al. [<xref rid="B17" ref-type="bibr">17</xref>]</td><td align="center" rowspan="1" colspan="1">14/—</td><td align="center" rowspan="1" colspan="1">M/— </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">Congenital UPJ obstruction</td><td align="center" rowspan="1" colspan="1">3 months</td><td align="center" rowspan="1" colspan="1">Methylprednisolone, OKT3</td><td align="center" rowspan="1" colspan="1">Amphotericin B, Fluconazole</td><td align="center" rowspan="1" colspan="1">India</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Died <break></break>(few days)</td></tr><tr><td align="left" rowspan="1" colspan="1">Tayyebi et al. [<xref rid="B19" ref-type="bibr">18</xref>]</td><td align="center" rowspan="1" colspan="1">31/—</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">DCD </td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">UPJ obstruction</td><td align="center" rowspan="1" colspan="1">2 months </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Iran</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Tayyebi et al. [<xref rid="B19" ref-type="bibr">18</xref>]</td><td align="center" rowspan="1" colspan="1">58/—</td><td align="center" rowspan="1" colspan="1">F/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Polycystic kidney disease</td><td align="center" rowspan="1" colspan="1">9 months </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Iran</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Survived</td></tr><tr><td align="left" rowspan="1" colspan="1">Tomazic et al. [<xref rid="B20" ref-type="bibr">19</xref>]</td><td align="center" rowspan="1" colspan="1">56/28</td><td align="center" rowspan="1" colspan="1">M/M</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">— </td><td align="center" rowspan="1" colspan="1">2 months</td><td align="center" rowspan="1" colspan="1">Tacrolimus and Methylprednisolone </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">India</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Died <break></break>(2 months)</td></tr><tr><td align="left" rowspan="1" colspan="1">Minz et al. [<xref rid="B21" ref-type="bibr">20</xref>]</td><td align="center" rowspan="1" colspan="1">52/—</td><td align="center" rowspan="1" colspan="1">M/—</td><td align="center" rowspan="1" colspan="1">LURD </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">Chronic glomerulonephritis</td><td align="center" rowspan="1" colspan="1">8 days</td><td align="center" rowspan="1" colspan="1">Cyclosporin, azathioprine, prednisolone, Basiliximab </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">India</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Died <break></break>(8 days)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ahmad [<xref rid="B18" ref-type="bibr">21</xref>]</td><td align="center" rowspan="1" colspan="1">49/—</td><td align="center" rowspan="1" colspan="1">M/M</td><td align="center" rowspan="1" colspan="1">LRRD</td><td align="center" rowspan="1" colspan="1">LRRD</td><td align="center" rowspan="1" colspan="1">Chronic glomerulonephritis</td><td align="center" rowspan="1" colspan="1">18 months</td><td align="center" rowspan="1" colspan="1">Cyclosporine, Prednisone, methylprednisolone, ATG </td><td align="center" rowspan="1" colspan="1">—</td><td align="center" rowspan="1" colspan="1">India</td><td align="center" rowspan="1" colspan="1"><italic>Mucor </italic>species</td><td align="center" rowspan="1" colspan="1">Died</td></tr></tbody></table><table-wrap-foot><fn><p>R: recipient; D: donor; M: male, F: female; —: no data available; PT: after transplant; SCD: standard criteria donor; ECD: extended criteria donor, DCD: donor after cardiac death; LURD: living unrelated donor; MVC: motor vehicle crash; yrs: years old; UPJ: ureteropelvic junction; US: United States; ATG: antithymocyte globulin.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>États-Unis</li></country></list><tree><country name="États-Unis"><noRegion><name sortKey="Kuy, Sreyram" sort="Kuy, Sreyram" uniqKey="Kuy S" first="Sreyram" last="Kuy">Sreyram Kuy</name></noRegion><name sortKey="Cronin, David C" sort="Cronin, David C" uniqKey="Cronin D" first="David C." last="Cronin">David C. 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