Diffuse glomerular basement membrane lamellation in renal allografts from pediatric donors to adult recipients

Tibor Nadasdy, Reza Abdi, Jan Pitha, Douglas Slakey, Lorraine Racusen

Research output: Contribution to journalArticle

Abstract

The transplantation of kidneys from pediatric cadaveric donors into adult recipients is performed in many centers. However, some studies indicate that the outcome of such renal transplants may be inferior compared with that of adult donors, particularly if the donor is an infant. Morphologic studies of failed pediatric donor kidneys in adult recipients describe various degrees of segmental or global glomerular sclerosis. The authors have performed ultrastructural examinations on such transplants and have identified six cases with diffuse irregular lamellation of the glomerular basement membrane (GBM), a change that may develop as early as 10 weeks after transplantation. The age of all donors was ≤6 years; three were infants. The incidence of the lesion was 9% at our institution in renal transplant patients who received a graft from donors <10 years old. Diffuse GBM lamellation has not been found in renal transplants from adult donors. Light microscopy showed various degrees of diffuse mesangial expansion, usually with segmental glomerular sclerosis. The patients had severe proteinuria. While recurrent focal segmental glomerular sclerosis (FSGS) has to be excluded, such diffuse GBM lamellation is generally not seen in recurrent FSGS cases. The pathogenesis of the lesion is most likely related to hyperperfusion injury of small pediatric donor kidneys grafted into adult recipients.

Original languageEnglish (US)
Pages (from-to)437-442
Number of pages6
JournalAmerican Journal of Surgical Pathology
Volume23
Issue number4
DOIs
StatePublished - Apr 1 1999

Keywords

  • Glomerular basement membrane
  • Pediatric donor
  • Renal allograft
  • Transplant glomerulopathy

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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