Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation

Abstract

The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p ¼ 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p ¼ 0.22 by logrank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p ¼ 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice.

Fibrin thrombi in deceased donor kidneys: Prevalence and influence on graft function and graft survival in transplanted patients

“…These findings are in contrast to a recent study by Batra et al. where 61 recipients with glomerular fibrin thrombi in the zero biopsy were compared with 557 controls. No difference in graft function or graft survival was found between the groups.…”

“…Using the criteria for AKI in the kidney donors as defined by Batra et al. , this condition was only present in three of the donors in the present study. All three donors were in the control group.…”

“…Acute kidney injury in donor was defined as latest s‐creatinine ≥177 μM (≥2.00 mg/dL) or dialysis according to Batra et al. .…”

“…Recently, Batra et al. reported that FT had no influence on future graft function. However, this was in a donor population with high prevalence of acute kidney injury (AKI).…”

Kidney transplantation from donors with rhabdomyolysis and acute renal failure

“…There were six kidneys that had a discolored appearance (from brown to glossy black), and pathological examination confirmed the black appearance of the kidneys was caused by massive myoglobin casts in the distal convoluted tubules. Because the recipient fibrinolytic system is effective in clearing the fibrin thrombi from the glomerular capillaries of the donor kidney, we accept kidney with <50% glomerular microtrombi …”