Korean J Transplant.  2022 Nov;36(Supple 1):S153. 10.4285/ATW2022.F-2728.

Thrombotic microangiopathy, rare cause of deceased donor acute kidney injury: is a donor biopsy necessary before donation?

• Kim SY

• KMID: 2535669
• DOI: http://doi.org/10.4285/ATW2022.F-2728

Abstract

Although deceased donor acute kidney injury (AKI) frequently leads to kidney discards. There is no significant difference in graft survival. However, since some causes are related to graft loss, evaluation based on objective criteria before transplantation should determine whether the kidney should be discarded. We reported a case who had thrombotic microangiopathy (TMA) in the graft kidney after deceased donor kidney transplantation (KT). A 25-year-old male with IgA nephropathy-induced endstage renal disease (ESRD) received KT from a deceased donor. Before the KT, the donor's initial serum creatinine (sCr) was 0.39, and the last sCr was 3.86 mg/dL, suggesting AKI. A zero-time protocol biopsy was performed on graft kidney immediately after vascular anastomosis, and the graft kidney's arterial resistance index (RI) showed 0.8. On light microscopy, TMA was observed in the tissue of the graft (Fig. 1). After transplantation, he was treated with hemodialysis due to delayed graft function for one month, and on postoperative day (POD) 36, he was discharged without hemodialysis. However, there was no significant im-provement in sCr (3.7–4.1) and eGFR (18–20 mL/min/1.73 m ² ). Even though deceased donor AKI is not related to graft survival, AKI caused by causes like the TMA almost results in graft loss. Therefore, for more effective and safe transplantation, donors accompanying AKI will need to undergo a preliminary examination to rule out the causes of AKI resulting in graft loss.