Journal List > J Korean Soc Transplant > v.30(1) > 1034500

J Korean Soc Transplant. 2016 Mar;30(1):31-34. Korean.
Published online March 31, 2016.
Copyright © 2016 The Korean Society for Transplantation
Delayed Graft Function Is Associated with Microvascular Thrombosis in a Donor with Disseminated Intravascular Coagulation
Yun Ju Cho, M.D.,1 Jee Wan Wee, M.D.,1 Soon Hyo Kwon, M.D.,1 Jin Seok Jeon, M.D.,1 Hyunjin Noh, M.D.,1 Dong Cheol Han, M.D.,1 Dan Song, M.D.,2 and So Young Jin, M.D.3
1Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
2Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.
3Department of Pathology, Soonchunhyang University College of Medicine, Seoul, Korea.

Corresponding author: Jin Seok Jeon. Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel: 82-2-709-9029, Fax: 82-2-792-5821, Email:
Received February 01, 2016; Revised February 22, 2016; Accepted February 24, 2016.


Microvascular thrombosis is an uncommon pathological finding in deceased donor kidneys. It is associated with disseminated intravascular coagulation (DIC) after brain injury in the donor. Although DIC in deceased kidney donors is known to have no association with graft outcome, microvascular thrombosis with DIC in a donor can cause renal graft impairment. For this reason, some transplantation centers do not accept these kidneys. A 39-year-old female donor had a subarachnoid hemorrhage. After a short period of cardiopulmonary resuscitation, we applied extracorporeal membrane oxygenation to maintain hemodynamic stability. The laboratory data were consistent with DIC. The recipient was a 38-year-old male patient who had been undergoing hemodialysis for 7 years because of end-stage renal disease of unknown cause. Zero-time graft biopsy revealed multiple intraluminal fibrin thrombi without peritubular capillaritis. Delayed graft function occurred after transplantation, and hemodialysis was started. Graft renal biopsy was performed on the third day after transplantation. The percentage of intraglomerular fibrin thrombi had decreased, and no significant peritubular capillaritis or C4d staining was observed. The function of the transplanted kidney started to recover, and hemodialysis was discontinued on the 10th day after surgery without specific treatment. Follow-up biopsy performed 20 days after the transplantation revealed normal kidney with completely resolved fibrin thrombi. We report herein a case of microvascular thrombosis in renal allograft from a DIC donor.

Keywords: Delayed graft function; Disseminated intravascular coagulation; Thrombosis


Fig. 1
Zero time biopsy shows markedly distended capillary lumens with multiple fibrin thrombi in the donor kidney (acid fuchsin orange G stain, ×200).
Click for larger image

Fig. 2
Intraglomerular fibrin thrombi was decreased. There was no evidence of peritubular capillaritis (acid fuchsin orange G stain, ×200).
Click for larger image

Fig. 3
Graft biopsy on postoperative day 20 shows nearly normal kidney. Fibrin thrombi seen in the previous biopsy are not found (PAS, ×200).
Click for larger image

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