Graft arteritis due to Candida spp. after kidney transplant: a systematic review of individual cases

Background Graft arteritis due to Candida species (GAC) is a rare but life-threatening complication in kidney transplant recipients. This systematic review examines its clinical profile and outcomes. Methods A PRISMA-compliant systematic review was conducted using PubMed, Embase, and Web of Science. Cases of GAC in kidney transplant recipients were identified and analysed for clinical characteristics and outcomes. Results Sixty-one patients from 31 studies were included. Median time to infection was 30 days (IQR: 12-60 days) post-transplant. Common symptoms included fever (41.5%) and abdominal pain (33.9%). Aneurysmal rupture occurred in 49.1%, often linked to early presentation. Candida albicans was the most frequent pathogen (86.9%). Surgical intervention, mainly external iliac artery ligation, was required in most cases. Mortality was 22.9% and was associated with candidemia and a significantly shorter interval between transplantation and clinical presentation. Conclusion GAC typically occurs early after kidney transplantation, with high rates of aneurysmal rupture and mortality. Prompt diagnosis and aggressive surgical management are essential.