Resolution of Glomerular Fibrin Thrombi in Deceased Donor Kidneys
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.
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).
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 October 10, 2024.« Back to 2015 American Transplant Congress