Successful Renal Transplantation of Deceased Donor Kidneys With 100% Glomerular Fibrin Thrombi and Acute Renal Failure Due To Disseminated Intravascular Coagulation

Kevin C. Soares, Lois J Arend, Bonnie E. Lonze, Niraj M Desai, Nada Alachkar, Fizza Naqvi, Robert A. Montgomery

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Disseminated intravascular coagulation (DIC) positive kidneys have historically been turned down for fear of poor outcomes. Higher severity injuries, which are prone to DIC, are typically seen in younger, otherwise healthy potential donors. The continued kidney allograft shortage has generated interest in the use of these DIC positive grafts. There have been some reports of acceptable outcomes of renal transplantation using kidneys from donors with DIC. There are multiple clinical series demonstrating good outcomes from DIC positive kidneys when the extent of glomeruli containing fibrin thrombi is less than 50% and donor renal function is preserved. These grafts are frequently associated with a period of delayed graft function. METHODS: We report 2 transplants with kidneys from brain dead donors with known DIC. RESULTS: Both donors had renal failure and pretransplant renal biopsies showing 100% of the glomeruli containing fibrin thrombi. The recipients experienced delayed graft function requiring hemodialysis which was discontinued on postoperative day 18 and 39 for case 1 and 2, respectively. Both patients are now over 14 months post transplant with stable allograft function. CONCLUSIONS: Until clearer organ selection criteria are established, caution should be exercised when considering the use of kidneys with a similar phenotype and allocation decisions made by a multi-disciplinary transplant team on a case-by-case basis.

Original languageEnglish (US)
JournalTransplantation
DOIs
StateAccepted/In press - Aug 3 2016

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Disseminated Intravascular Coagulation
Fibrin
Acute Kidney Injury
Kidney Transplantation
Thrombosis
Tissue Donors
Kidney
Transplants
Delayed Graft Function
Allografts
Brain Death
Patient Selection
Fear
Renal Insufficiency
Renal Dialysis
Phenotype
Biopsy
Wounds and Injuries

ASJC Scopus subject areas

  • Medicine(all)
  • Transplantation

Cite this

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title = "Successful Renal Transplantation of Deceased Donor Kidneys With 100{\%} Glomerular Fibrin Thrombi and Acute Renal Failure Due To Disseminated Intravascular Coagulation",
abstract = "BACKGROUND: Disseminated intravascular coagulation (DIC) positive kidneys have historically been turned down for fear of poor outcomes. Higher severity injuries, which are prone to DIC, are typically seen in younger, otherwise healthy potential donors. The continued kidney allograft shortage has generated interest in the use of these DIC positive grafts. There have been some reports of acceptable outcomes of renal transplantation using kidneys from donors with DIC. There are multiple clinical series demonstrating good outcomes from DIC positive kidneys when the extent of glomeruli containing fibrin thrombi is less than 50{\%} and donor renal function is preserved. These grafts are frequently associated with a period of delayed graft function. METHODS: We report 2 transplants with kidneys from brain dead donors with known DIC. RESULTS: Both donors had renal failure and pretransplant renal biopsies showing 100{\%} of the glomeruli containing fibrin thrombi. The recipients experienced delayed graft function requiring hemodialysis which was discontinued on postoperative day 18 and 39 for case 1 and 2, respectively. Both patients are now over 14 months post transplant with stable allograft function. CONCLUSIONS: Until clearer organ selection criteria are established, caution should be exercised when considering the use of kidneys with a similar phenotype and allocation decisions made by a multi-disciplinary transplant team on a case-by-case basis.",
author = "Soares, {Kevin C.} and Arend, {Lois J} and Lonze, {Bonnie E.} and Desai, {Niraj M} and Nada Alachkar and Fizza Naqvi and Montgomery, {Robert A.}",
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T1 - Successful Renal Transplantation of Deceased Donor Kidneys With 100% Glomerular Fibrin Thrombi and Acute Renal Failure Due To Disseminated Intravascular Coagulation

AU - Soares, Kevin C.

AU - Arend, Lois J

AU - Lonze, Bonnie E.

AU - Desai, Niraj M

AU - Alachkar, Nada

AU - Naqvi, Fizza

AU - Montgomery, Robert A.

PY - 2016/8/3

Y1 - 2016/8/3

N2 - BACKGROUND: Disseminated intravascular coagulation (DIC) positive kidneys have historically been turned down for fear of poor outcomes. Higher severity injuries, which are prone to DIC, are typically seen in younger, otherwise healthy potential donors. The continued kidney allograft shortage has generated interest in the use of these DIC positive grafts. There have been some reports of acceptable outcomes of renal transplantation using kidneys from donors with DIC. There are multiple clinical series demonstrating good outcomes from DIC positive kidneys when the extent of glomeruli containing fibrin thrombi is less than 50% and donor renal function is preserved. These grafts are frequently associated with a period of delayed graft function. METHODS: We report 2 transplants with kidneys from brain dead donors with known DIC. RESULTS: Both donors had renal failure and pretransplant renal biopsies showing 100% of the glomeruli containing fibrin thrombi. The recipients experienced delayed graft function requiring hemodialysis which was discontinued on postoperative day 18 and 39 for case 1 and 2, respectively. Both patients are now over 14 months post transplant with stable allograft function. CONCLUSIONS: Until clearer organ selection criteria are established, caution should be exercised when considering the use of kidneys with a similar phenotype and allocation decisions made by a multi-disciplinary transplant team on a case-by-case basis.

AB - BACKGROUND: Disseminated intravascular coagulation (DIC) positive kidneys have historically been turned down for fear of poor outcomes. Higher severity injuries, which are prone to DIC, are typically seen in younger, otherwise healthy potential donors. The continued kidney allograft shortage has generated interest in the use of these DIC positive grafts. There have been some reports of acceptable outcomes of renal transplantation using kidneys from donors with DIC. There are multiple clinical series demonstrating good outcomes from DIC positive kidneys when the extent of glomeruli containing fibrin thrombi is less than 50% and donor renal function is preserved. These grafts are frequently associated with a period of delayed graft function. METHODS: We report 2 transplants with kidneys from brain dead donors with known DIC. RESULTS: Both donors had renal failure and pretransplant renal biopsies showing 100% of the glomeruli containing fibrin thrombi. The recipients experienced delayed graft function requiring hemodialysis which was discontinued on postoperative day 18 and 39 for case 1 and 2, respectively. Both patients are now over 14 months post transplant with stable allograft function. CONCLUSIONS: Until clearer organ selection criteria are established, caution should be exercised when considering the use of kidneys with a similar phenotype and allocation decisions made by a multi-disciplinary transplant team on a case-by-case basis.

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