Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi after Deceased Donor Kidney Transplantation

R. K. Batra, R. L. Heilman, M. L. Smith, Leslie Francis Thomas, H. A. Khamash, N. N. Katariya, W. R. Hewitt, A. L. Singer, Amit Mathur, J. Huskey, Harini M Chakkera, A. Moss, Kunam Sudhakar Reddy

Research output: Contribution to journalArticle

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Abstract

The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p = 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p = 0.22 by log-rank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p = 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice. Deceased donor kidneys with glomerular fibrin thrombi can have excellent graft survival, as fibrin thrombi resolve by one month in most cases without any deleterious effect on renal function or biopsy findings at one year.

Original languageEnglish (US)
Pages (from-to)1015-1020
Number of pages6
JournalAmerican Journal of Transplantation
Volume16
Issue number3
DOIs
StatePublished - Mar 1 2016

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Fibrin
Kidney Transplantation
Thrombosis
Tissue Donors
Biopsy
Kidney
Control Groups
Graft Survival
Delayed Graft Function
Atrophy
Creatinine
Fibrosis
Cohort Studies
Transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi after Deceased Donor Kidney Transplantation. / Batra, R. K.; Heilman, R. L.; Smith, M. L.; Thomas, Leslie Francis; Khamash, H. A.; Katariya, N. N.; Hewitt, W. R.; Singer, A. L.; Mathur, Amit; Huskey, J.; Chakkera, Harini M; Moss, A.; Reddy, Kunam Sudhakar.

In: American Journal of Transplantation, Vol. 16, No. 3, 01.03.2016, p. 1015-1020.

Research output: Contribution to journalArticle

Batra, RK, Heilman, RL, Smith, ML, Thomas, LF, Khamash, HA, Katariya, NN, Hewitt, WR, Singer, AL, Mathur, A, Huskey, J, Chakkera, HM, Moss, A & Reddy, KS 2016, 'Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi after Deceased Donor Kidney Transplantation', American Journal of Transplantation, vol. 16, no. 3, pp. 1015-1020. https://doi.org/10.1111/ajt.13561
Batra, R. K. ; Heilman, R. L. ; Smith, M. L. ; Thomas, Leslie Francis ; Khamash, H. A. ; Katariya, N. N. ; Hewitt, W. R. ; Singer, A. L. ; Mathur, Amit ; Huskey, J. ; Chakkera, Harini M ; Moss, A. ; Reddy, Kunam Sudhakar. / Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi after Deceased Donor Kidney Transplantation. In: American Journal of Transplantation. 2016 ; Vol. 16, No. 3. pp. 1015-1020.
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AU - Thomas, Leslie Francis

AU - Khamash, H. A.

AU - Katariya, N. N.

AU - Hewitt, W. R.

AU - Singer, A. L.

AU - Mathur, Amit

AU - Huskey, J.

AU - Chakkera, Harini M

AU - Moss, A.

AU - Reddy, Kunam Sudhakar

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N2 - The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p = 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p = 0.22 by log-rank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p = 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice. Deceased donor kidneys with glomerular fibrin thrombi can have excellent graft survival, as fibrin thrombi resolve by one month in most cases without any deleterious effect on renal function or biopsy findings at one year.

AB - The aim of this study was to determine the clinical and histologic outcomes related to transplanting kidneys from deceased donors with glomerular fibrin thrombi (GFT). We included all cases transplanted between October 2003 and October 2014 that had either a preimplantation biopsy or an immediate postreperfusion biopsy showing GFT. The study cohort included 61 recipients (9.9%) with GFT and 557 in the control group without GFT. Delayed graft function occurred in 49% of the GFT group and 39% in the control group (p = 0.14). Serum creatinine at 1, 4, and 12 months and estimated GFR at 12 months were similar in the two groups. Estimated 1-year graft survival was 93.2% in the GFT group and 95.1% in the control group (p = 0.22 by log-rank). Fifty-two of the 61 patients in the GFT group (85%) had a 1-month protocol biopsy, and only two biopsies (4%) showed residual focal glomerular thrombi. At the 1-year protocol biopsy, the prevalence of moderate to severe interstitial fibrosis and tubular atrophy was 24% in the GFT group and 30% in the control group (p = 0.42). We concluded that GFT resolves rapidly after transplantation and that transplanting selected kidneys from deceased donors with GFT is a safe practice. Deceased donor kidneys with glomerular fibrin thrombi can have excellent graft survival, as fibrin thrombi resolve by one month in most cases without any deleterious effect on renal function or biopsy findings at one year.

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