J Korean Soc Transplant.  2016 Mar;30(1):31-34. 10.4285/jkstn.2016.30.1.31.

Delayed Graft Function Is Associated with Microvascular Thrombosis in a Donor with Disseminated Intravascular Coagulation

• Cho YJ
• Wee JW
• Kwon SH
• Jeon JS
• Noh H
• Han DC
• Song D
• Jin SY

• KMID: 2202625
• DOI: http://doi.org/10.4285/jkstn.2016.30.1.31

Abstract

Microvascular thrombosis is an uncommon pathological finding in deceased donor kidneys. It is associated with disseminated intravascular coagulation (DIC) after brain injury in the donor. Although DIC in deceased kidney donors is known to have no association with graft outcome, microvascular thrombosis with DIC in a donor can cause renal graft impairment. For this reason, some transplantation centers do not accept these kidneys. A 39-year-old female donor had a subarachnoid hemorrhage. After a short period of cardiopulmonary resuscitation, we applied extracorporeal membrane oxygenation to maintain hemodynamic stability. The laboratory data were consistent with DIC. The recipient was a 38-year-old male patient who had been undergoing hemodialysis for 7 years because of end-stage renal disease of unknown cause. Zero-time graft biopsy revealed multiple intraluminal fibrin thrombi without peritubular capillaritis. Delayed graft function occurred after transplantation, and hemodialysis was started. Graft renal biopsy was performed on the third day after transplantation. The percentage of intraglomerular fibrin thrombi had decreased, and no significant peritubular capillaritis or C4d staining was observed. The function of the transplanted kidney started to recover, and hemodialysis was discontinued on the 10th day after surgery without specific treatment. Follow-up biopsy performed 20 days after the transplantation revealed normal kidney with completely resolved fibrin thrombi. We report herein a case of microvascular thrombosis in renal allograft from a DIC donor.

Keyword

Delayed graft function; Disseminated intravascular coagulation; Thrombosis

MeSH Terms

Adult
Allografts
Biopsy
Brain Injuries
Cardiopulmonary Resuscitation
Dacarbazine
Delayed Graft Function*
Disseminated Intravascular Coagulation*
Extracorporeal Membrane Oxygenation
Female
Fibrin
Follow-Up Studies
Hemodynamics
Humans
Kidney
Kidney Failure, Chronic
Male
Renal Dialysis
Subarachnoid Hemorrhage
Thrombosis*
Tissue Donors*
Transplants
Dacarbazine
Fibrin

Figure

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  Fig. 1. Zero time biopsy shows markedly distended capillary lumens with multiple fibrin thrombi in the donor kidney (acid fuchsin orange G stain, ×200).

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  Fig. 2. Intraglomerular fibrin thrombi was decreased. There was no evidence of peritubular capillaritis (acid fuchsin orange G stain, ×200).

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  Fig. 3. Graft biopsy on postoperative day 20 shows nearly normal kidney. Fibrin thrombi seen in the previous biopsy are not found (PAS, ×200).

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