Prognostic significance of microvascular thrombosis in donor kidney allograft biopsies.
BACKGROUND
With a continuing demand for donor kidneys for organ transplantation, it is important to understand the significance of pathologic findings in the donor organ before transplantation. Microvascular thrombosis is sometimes encountered in association with disseminated intravascular coagulation in the donor, and it is unclear whether this finding may affect immediate allograft function and long-term graft survival. To further elucidate this question, we examined our experience with microvascular thrombosis in donor biopsies in the kidney transplant program at our institution.


METHODS
Donor kidney biopsies showing microvascular thrombosis were identified from consecutive donor biopsies in the Duke University Medical Center transplant file database between January 1, 1995 and December 31, 2000. These biopsies and all other kidney biopsies and specimens from the recipients of these kidneys thus identified were reviewed. Sections were stained using a variety of methods, including hematoxylin-eosin, periodic acid-Schiff, methenamine silver, and Masson trichrome methods. Clinical records of the transplant recipients of these kidneys were also reviewed to assess allograft performance and survival.


RESULTS
From 230 consecutive donor kidney biopsies, we identified eight cases exhibiting donor-microvascular thrombosis. Mean follow-up times were 27.5 months for the thrombi group and 35 months for the non-thrombi group. Recipients of grafts with donor thrombi were more likely to exhibit delayed graft function, but graft function at 1 and 2 years and graft survival were similar between the two groups. Subsequent posttransplantation biopsies in five of eight cases showed no evidence of residual thrombosis.


CONCLUSIONS
These data suggest that the presence of donor microvascular thrombosis does not portend poor outcome in renal transplantation.
McCall
Shannon J
SJ
Department of Pathology, Duke University Medical Center, Durham, NC, USA.
Tuttle-Newhall
Janet E
JE
Howell
David N
DN
Fields
Timothy A
TA
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000473:pathology*; D014019:Tissue Donors