Successful kidney transplantation using organs from a donor with disseminated intravascular coagulation and impaired renal function: case report and review of the literature

Pastural, Myriam; Barrou, B.; Delcourt, A; Bitker, Marc‐Olivier; Ourahma, S.; Richard, François

doi:10.1093/ndt/16.2.412

Cited by 20 publications

(17 citation statements)

References 5 publications

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“… and Pastural et al. both reported excellent graft function after renal transplantation from deceased donors with glomerular thrombi and DIC. Recently, Soares et al.…”

Section: Discussionmentioning

confidence: 93%

“…Several case reports of recipients having donor kidneys with glomerular thrombi due to DIC have been published . Bennett et al.…”

Section: Discussionmentioning

confidence: 99%

“…The histologic picture of these fibrin thrombi (Figs A,B and ) resembles what is found in thrombotic microangiopathy, a condition associated with a poor prognosis for graft survival . The importance of FT in the zero biopsy for future graft function has been described with great discrepancy in case reports . Only two cohort studies have systematically looked into whether the presence of FT in deceased donor kidney zero biopsy influences future graft function.…”

mentioning

confidence: 93%

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

Hansen

Rørvig

Andersen

et al. 2017

APMIS

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CB, Sørensen SS. Fibrin thrombi in deceased donor kidneys: Prevalence and influence on graft function and graft survival in transplanted patients. APMIS 2018; 126: 3-8.Fibrin thrombi (FT) are occasionally found in the pre-implantation biopsy of kidneys from deceased donors. The aim of this study was to monitor the prevalence and answer the question whether FT has any impact on future graft function in a Danish patient cohort. We looked for FT in all donor kidney biopsies taken at the time of renal transplantation in a Danish transplantation unit during a 10-year period. Every recipient transplanted with a FT donor kidney (n = 15) were matched with up to five control recipients (n = 69), and graft function and graft survival were assessed. FT was present in 3% of the transplanted donor kidneys. Graft function was reduced in the FT group 6 months after transplantation (median estimated glomerular filtration rate (eGFR): 29 mL/min vs 46 mL/min; p = 0.017), but at 12 months, an apparent difference did not reach statistical significance. More patients were on dialysis in the FT group after 12 months compared with the control group (27% vs 6%; p = 0.049). In conclusion, FT in donor kidney biopsies at time of transplantation is a risk factor for the development of reduced renal function during the first year of transplantation.

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“… and Pastural et al. both reported excellent graft function after renal transplantation from deceased donors with glomerular thrombi and DIC. Recently, Soares et al.…”

Section: Discussionmentioning

confidence: 93%

“…Several case reports of recipients having donor kidneys with glomerular thrombi due to DIC have been published . Bennett et al.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 93%

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

Hansen

Rørvig

Andersen

et al. 2017

APMIS

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“…Because this is so universally accepted, it is not well detailed in the literature. A few small studies detail use of kidneys from donors with disseminated intravascular coagulation (DIC) and glomerular microthrombi, reporting no impact on graft function [6][7][8]. One center treated kidneys with microthrombi with tPA prior to implantation and yielded initial good results [9].…”

Section: Discussionmentioning

confidence: 99%

Successful Kidney Transplant Despite Microthrombi From a Deceased Donor With Heparin Induced Thrombocytopenia

Osband

2014

J Curr Surg

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Many deceased donor factors determine utility of procured organs. In addition to the large dose of intravenous heparin usually given prior to aortic cross-clamp, kidneys are flushed with heparinized solution pre-implantation. In a donor with heparin induced thrombocytopenia (HIT), these exposures may lead to microthrombi, which may be a reason to refuse a kidney offer. We present a case of successful renal transplantation of a highly sensitized patient from a donor with HIT and microthrombi on biopsy.

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“…A few reports in the literature describe transplantation of kidneys from organ donors with DIC [6][7][8]. In most of these reports DIC was not associated with renal dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Kidney Transplantation from Donors with Severe Disseminated Intravascular Coagulation

Sibulesky

Gohh

Charpentier

et al. 2013

ISRN Transplantation

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Disseminated intravascular coagulation (DIC) is a syndrome characterized by massive formation of thrombin, which can lead to renal dysfunction or failure. Many transplant centers are reluctant to accept the kidneys from donors with DIC especially if renal dysfunction is present. We developed protocol of machine perfusion followed by tissue plasminogen activator (tPA) infusion in order to treat and evaluate DIC kidneys prior to transplantation. The kidneys were placed on machine preservation with tPA added to the perfusate prior to transplantation. Three kidneys were transplanted from two donors who sustained gunshot injuries to the brain. A biopsy at the time of organ recovery documented widespread fibrin thrombi in approximately 80% of the glomeruli. Serial biopsies showed interval improvement following machine perfusion and a normal appearing kidney three months after successful transplantation. The histological presence of DIC in a deceased organ donor, even if associated with renal dysfunction, is not a contraindication to renal transplantation. Machine perfusion and tPA infusions may contribute to the recovery and successful transplantation of such kidneys.

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Successful kidney transplantation using organs from a donor with disseminated intravascular coagulation and impaired renal function: case report and review of the literature

Cited by 20 publications

References 5 publications

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

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

Successful Kidney Transplant Despite Microthrombi From a Deceased Donor With Heparin Induced Thrombocytopenia

Kidney Transplantation from Donors with Severe Disseminated Intravascular Coagulation

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