Resolution of Glomerular Fibrin Thrombi in Deceased Donor Kidneys

R. Batra,¹ M. Smith,³ L. Thomas,² H. Khamash,² A. Moss,² J. Huskey,² A. Singer,¹ A. Mathur,¹ N. Katariya,¹ K. Reddy,¹ R. Heilman.²

¹Transplant Surgery, Mayo Clinic, Phoenix, AZ
²Transplant Nephrology, Mayo Clinic, Phoenix, AZ
³Pathology, Mayo Clinic, Phoenix, AZ.

Meeting: 2015 American Transplant Congress

Abstract number: 471

Keywords: Donors, Kidney transplantation, marginal

Session Information

Session Name: Concurrent Session: Kidney: Risk Prediction

Session Type: Concurrent Session

Date: Tuesday, May 5, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 4:36pm-4:48pm

Location: Room 120-ABC

Background

Deceased donor kidneys with Glomerular Fibrin Thrombi (GFT) are frequently discarded, but these kidneys may offer an opportunity to increase deceased donor organs. Our aim was to determine clinical and histologic outcomes after transplanting deceased donor kidneys with GFT.

Patients and methods

We reviewed pre-implantation frozen biopsy (pre-Bx) and reperfusion biopsies of all deceased donors kidneys transplanted at our center between 2004 and 2014. We identified 61 (9.9%) transplanted kidneys with focal (<50%) or diffuse (>50%) GFT, and 557 without GFT.

Results

There were 61 kidneys with GFT; 21 (34%) diffuse and 40 (66%) focal GFT and 557 without GFT (table 1). 16 allografts had both a pre-Bx and post re-perfusion time 0 biopsy. Both pre-Bx and time 0 biopsy showed GFT in all but 3 cases in which the GFT was seen on time 0 biopsy alone. All allografts had biopsy documented resolution of GFT by 12 months and only 6 (10%) had residual thrombi on either 1 or 4 month protocol biopsy.

1. Baseline characteristics
	GFT cohort (n=61)	Control (557)	p value
Recipient Age	53.6 ±14.7	55.6±12.2	0.24
Recipient Female	41%	42%	0.84
Recipient Race Black	13%	13%	0.94
Donor Age	37.9±15.2	41.0±16.7	0.16
Donor Male	57%	61%	0.54
Donation after Cardiac Death	4.9%	11.9%	0.07
Donor Terminal Creatinine	2.93±2.21	1.73±2.01	<0.0001
Cold Ischemic Time	19.5±8.2	17.3±7.7	0.04
Pulsatile Perfusion Pump	52%	38%	0.03

Graft survival at 1 year was 88.9% for diffuse GFT, 94.1% for focal GFT and 94.3% for the control group (log rank p=0.64). Graft loss occurred in 7 out of 61 (11.5%) in the GFT cohort (1 due to primary non function, 2 due to graft thrombosis, 2 due to acute rejection, 2 due to late patient death).

The eGFR and Banff biopsy 'ci' scores were not statistical different between the two groups at 1 year (table 2).

2. Graft Outcomes
	GFT cohort	Control	p value
Delayed Graft Function	48%	37%	0.10
1 month creatinine	1.99±1.28	1.77±1.08	0.13
1 year creatinine	1.55±1.11	1.40±0.88	0.45
1 year eGFR	59.8±24.4	58.6±20.0	0.73
1 year eGFR<30mls/minute/1.73m²	9.8%	5.5%	0.31
1 year biopsy Banff ci>1	23%	31%	0.40

Conclusion

GFT in deceased donor kidneys will resolve without a significant impact on histologic findings, GFR or graft outcomes.

Presence of GFT in deceased donor kidneys is not a contraindication to transplantation.

To cite this abstract in AMA style:

Batra R, Smith M, Thomas L, Khamash H, Moss A, Huskey J, Singer A, Mathur A, Katariya N, Reddy K, Heilman R. Resolution of Glomerular Fibrin Thrombi in Deceased Donor Kidneys [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/resolution-of-glomerular-fibrin-thrombi-in-deceased-donor-kidneys/. Accessed November 24, 2024.

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