Candida graft arteritis after kidney transplantation: two cases and literature review

Background: Candida arteritis of a kidney allograft represents a severe yet rare complication in transplant recipients. Its nonspecific presentation and diagnostic difficulties necessitate a high level of clinical suspicion and a multidisciplinary approach to management. Case presentation: We report two cases of Candida arteritis in kidney transplant recipients who presented with life-threatening bleeding from the graft anastomotic site shortly after transplantation. Histopathological examination revealed fungal invasion of the arterial walls, with periodic acid-Schiff (PAS) staining demonstrating budding yeast cells and pseudo hyphae. Both patients underwent emergency graft nephrectomy and iliac vessel repair. Antifungal therapy with intravenous fluconazole was initiated. Despite these interventions, one patient succumbed to a rebleed ten days postoperatively, while the other survived but experienced graft loss. Conclusion: This report highlights the importance of early recognition, maintenance of sterile conditions during organ transport and vigilant postoperative monitoring to minimise the occurrence of this life-threatening complication burden.