Glomerulopathy in Adult Recipients of Pediatric Kidneys

Choung, Hae Yoon Grace; Meleg-Smith, Suzanne

doi:10.3109/01913123.2014.888112

Cited by 5 publications

(8 citation statements)

References 39 publications

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“…Compared to diffuse AS-like GBM change reported by Nadasdy et al, 20 only 3 cases in our series showed diffuse lesion, while the other 4 only segmental. Choung and Meleg-Smith 15 described that PDG affected GBM mainly on the epithelial side, external lamina rara, while in our series both the internal and external lamina rara were thickened.…”

Section: Discussioncontrasting

confidence: 41%

“…Four of the 6 grafts developed dysfunction after 3 months to 3 years posttransplantation, and in all cases AS was excluded. In 2014, Choung and Meleg-Smith 15 reported a unique lesion of the glomerular in pediatric grafts transplanted into adults identifiable on electron microscopy, and named the lesion PDG.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of posttransplant proteinuria is higher in adults who received small PDK compared to those who received ADK. 12 - 14 Choung et al 15 found that adults who received kidneys from pediatric donors < 10 years old had a higher incidence of a special glomerulopathy, pediatric donor glomerulopathy (PDG), which is characterized by spitting and lamination of the glomerular basement membrane (GBM), similar to the lesions seen in kidney of Alport syndrome (AS).…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

et al. 2019

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Background. Reports about prognosis of adults receiving small pediatric-donor kidneys (PDK) as compared to those receiving elder pediatric or adult donor kidneys (ADKs) are controversial. This study aimed to examine the outcomes of adults receiving small PDK and possible prognostic factors. Methods. The records of adults who received kidneys from donors < 10 years old at our center from July 1, 2011 to June 30, 2018 were reviewed. Results. A total of 121 adults were small PDK recipients. Twenty-three patients received 29 biopsies or nephrectomy between 6 and 896 days posttransplantation days. Seven patients (30.4%) had pediatric donor glomerulopathy (PDG), which developed from 113 to 615 days posttransplantation. The incidence of proteinuria and hematuria was significantly higher in the PDG group. The characteristic pathological finding in PDG was irregular lamination and splintering of the glomerular basement membrane (GBM). Donor age, donor weight, and donor kidney volume were significantly less in PDG cases compared with the non-PDG cases. For the risk factors of PDG, increasing urinary RBC count during follow-up was an independent predictor, while increasing donor age and body weight were protective factors. PDG was not a significant risk factor for Scr increasing of PDKs. Conclusions. PDG is a potential cause of abnormal urinalysis in adults receiving small PDKs. The pathological characteristic change of PDG is splitting and lamination of GBM. Persistent hematuria after transplantation in recipients of PDK is a predictor of PDG development.

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

et al. 2019

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“…Organ size mismatch, i.e., typically a too-small-forbody-size transplant as a cause for allograft dysfunction, proteinuria, and glomerular remodeling was first described by Truong et al in 1991 [7]. Truong's observations were subsequently further characterized by Nadasdy et al and Choung et al [8,9], reporting glomerulopathies in 9% of adult patients receiving donor kidneys from patients younger than 10 years of age. The authors described marked alterations of the glomerular filtration barrier very similar to the currently made observations.…”

Section: Discussionmentioning

confidence: 99%

C4d-expressing glomerulopathy and proteinuria post transplantation of a  too-big-for-size mismatched kidney allograft: An unusual case with good outcome

Gougeon¹,

Mikhailov²,

Gibson³

et al. 2017

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A 5-year-old severely growth-retarded child with tubulointerstitial, oliguric end-stage renal disease received an adult-size kidney transplant. Three years post grafting under standard triple immunosuppression (mycophenolate mofetil, tacrolimus, and prednisone) de novo nephrotic range proteinuria without the nephrotic syndrome developed. Graft function was normal (serum creatinine: 0.2 - 0.3 mg/dL), there were no donor-specific HLA antibodies (DSA), and the urine sediment was inactive. Two biopsies collected 3 and 4 years post-transplantation showed severe glomerular capillary wall remodeling and associated pseudolinear C4d staining as morphologic correlates for the proteinuria. Changes resembled those seen in so-called "size-mismatch transplant glomerulopathies". There was no evidence of a glomerulonephritis, acute or chronic rejection including transplant glomerulopathy, interstitial fibrosis, peritubular capillary C4d deposits, or multilamination of peritubular capillary basement membranes. The glomerular changes were not detected in the implantation zero-hour biopsy or the recipient's native renal biopsy. At the end of follow-up 64 months post transplantation, proteinuria persisted at subnephrotic levels in the setting of stable graft function and undetectable DSAs. This unique case adds to the list of causes of nonrejection-associated post-transplant proteinuria. It demonstrates for the first time that a too-large-for-body-size mismatched graft is associated with a presumably sheer stress-induced C4d expressing glomerulopathy, severe proteinuria, and favorable outcome. .

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“… 5 Despite the comparable long-term outcome concerning glomerular filtration rate (GFR) in these recipients, there are scarce data about development of hyperfiltration injury in these small pediatric donors, especially focusing on proteinuria and histological changes. 17 , 18 Of note, surveillance biopsies were not performed routinely.…”

Section: Introductionmentioning

confidence: 99%

Excellent Clinical Long-Term Outcomes of Kidney Transplantation From Small Pediatric Donors (Age ≤ 5 Years) Despite Early Hyperfiltration Injury

Burkhalter

Holzmann

Georgalis

et al. 2023

Can J Kidney Health Dis

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Background: The use of small pediatric donors (age ≤ 5 years and body weight < 20kg) for adult transplant recipients is still regarded controversially in terms of early complications, long-term outcomes, and development of hyperfiltration injury due to body size mismatch. Objective: To investigate long-term outcomes of adult renal allograft recipients receiving a kidney from small pediatric donor (SPD) in terms of kidney function and early features of hyperfiltration injury such as histological changes and proteinuria. Design: Retrospective, single center study. Settings: Transplant center of the University Hospital of Basel, Switzerland. Patients: Adult renal allograft recipients receiving a kidney from a small pediatric donor at our center between 2005 and 2017. Methods: The outcome of 47 transplants from SPD were compared with 153 kidney transplants from deceased-standard criteria donors (SCD) occurring during the same time period. Incidence of clinical signs of hyperfiltration injury (eg, proteinuria) was investigated. According to our policy, surveillance biopsies were taken at 3 and 6 months post-transplant and were evaluated in terms of signs of hyperfiltration injury. Results: At a median follow-up of 2.3 years post-transplant, death-censored graft survival of SPD was comparable to transplants from SCD (94% vs 93%; P = .54). Furthermore, allograft function at last follow-up (estimated glomerular filtration rate–Modification of Diet in Renal Disease) was significantly higher in pediatric transplant (80 vs 55 ml/min/1.73 m2, P = .002). We found histological signs of early hyperfiltration injury in 55% of SPD. There was an equally low proteinuria in both groups during follow-up. Limitations: It is a single center and retrospective observational study with small sample size. The outcomes were investigated in a well-selected population of recipients with low body mass index, low immunological risk, and well-controlled hypertension and was not compared with equal selected group of recipients. Conclusions: Early histological and clinical signs of hyperfiltration injury in SPD is frequent. Despite the hyperfiltration injury, there is an equal allograft survival and even superior allograft function in SPD compared with SCD during follow-up. This observation supports the concept of high adaptive capacity of pediatric donor kidneys.

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Glomerulopathy in Adult Recipients of Pediatric Kidneys

Cited by 5 publications

References 39 publications

Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

C4d-expressing glomerulopathy and proteinuria post transplantation of a  too-big-for-size mismatched kidney allograft: An unusual case with good outcome

Excellent Clinical Long-Term Outcomes of Kidney Transplantation From Small Pediatric Donors (Age ≤ 5 Years) Despite Early Hyperfiltration Injury

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Glomerulopathy in Adult Recipients of Pediatric Kidneys

Cited by 5 publications

References 39 publications

Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

C4d-expressing glomerulopathy and proteinuria post transplantation of a too-big-for-size mismatched kidney allograft: An unusual case with good outcome

Excellent Clinical Long-Term Outcomes of Kidney Transplantation From Small Pediatric Donors (Age ≤ 5 Years) Despite Early Hyperfiltration Injury

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Product

Resources

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C4d-expressing glomerulopathy and proteinuria post transplantation of a  too-big-for-size mismatched kidney allograft: An unusual case with good outcome