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.  https://doi.org/10.4285/jkstn.2016.30.1.31
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: jeonjs@shcmc.ac.kr
Received February 01, 2016; Revised February 22, 2016; Accepted February 24, 2016.

Abstract

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

Figures


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

References
1. McCall SJ, Tuttle-Newhall JE, Howell DN, Fields TA. Prognostic significance of microvascular thrombosis in donor kidney allograft biopsies. Transplantation 2003;75:1847–1852.
2. Kang HR, Kwon SS, Yoon SY, Kim EN, Kwon SH, Jeon JS, et al. Treatment of presumptive BK nephropathy with ciprofloxain in kidney transplant recipients: three case reports. J Korean Soc Transplant 2014;28:254–258.
3. Hefty TR, Cotterell LW, Fraser SC, Goodnight SH, Hatch TR. Disseminated intravascular coagulation in cadaveric organ donors. Incidence and effect on renal transplantation. Transplantation 1993;55:442–443.
4. Wang CJ, Shafique S, McCullagh J, Diederich DA, Winklhofer FT, Wetmore JB. Implications of donor disseminated intravascular coagulation on kidney allograft recipients. Clin J Am Soc Nephrol 2011;6:1160–1167.
5. Pastural M, Barrou B, Delcourt A, Bitker MO, Ourahma S, Richard F. Successful kidney transplantation using organs from a donor with disseminated intravascular coagulation and impaired renal function: case report and review of the literature. Nephrol Dial Transplant 2001;16:412–415.
6. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med 1999;341:586–592.
7. Wada T, Gando S, Mizugaki A, Yanagida Y, Jesmin S, Yokota H, et al. Coagulofibrinolytic changes in patients with disseminated intravascular coagulation associated with postcardiac arrest syndrome: fibrinolytic shutdown and insufficient activation of fibrinolysis lead to organ dysfunction. Thromb Res 2013;132:e64–e69.
8. Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc 2013;15:172–178.
9. Plotz FB, van Oeveren W, Bartlett RH, Wildevuur CR. Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg 1993;105:823–832.
10. Reed RC, Rutledge JC. Laboratory and clinical predictors of thrombosis and hemorrhage in 29 pediatric extracorporeal membrane oxygenation nonsurvivors. Pediatr Dev Pathol 2010;13:385–392.
11. Nghiem DD, Olson PR, Sureshkumar KK. Role of pulsatile perfusion with tissue plasminogen activator in deceased donor kidneys with extensive glomerular thrombosis. Transplant Proc 2009;41:29–31.
TOOLS
Similar articles

Two Cases of Adult Onset Still's Disease with Disseminated Intravascular Coagulation and Multiple Organ Involvement Treated with Cyclosporine

Advanced Gastric Cancer Associated with Disseminated Intravascular Coagulation Successfully Treated with 5-fluorouracil and Oxaliplatin

Disseminated Intravascular Coagulation Following Septic Shock in Multiple Open Fractures : a Case Report

A Case of Gastric Cancer Presenting Acute Disseminated Intravascular Coagulation Palliated with Combination Chemotherapy of Irinotecan and Cisplatin

A Fatal Case of Intravascular Coagulation After Bee Sting Acupuncture