title: Microscopic intrarenal particles after pulsatile machine preservation do not adversely affect outcomes after renal transplantation.
abstract: BACKGROUND
  Our center has recently observed foreign carbohydrate-appearing particles (FP) on transplant postreperfusion biopsy specimens: (PRBx).
  
  
  METHODS
  To further characterize FPs, we reviewed all renal transplant RBx (30-45 minutes) performed between September 1, 2004 and December 3, 2005. Donor, preservation, and outcome variables were collected among patients with FP.
  
  
  RESULTS
  A total of 135 PRBx were performed (45 deceased donors [DD] and 90 live donors [LD]). Fifteen PRBx demonstrated FP. All 15 cases were DD kidneys that underwent machine perfusion (MP) on the Waters RM3 (Waters Medical Systems, Rochester, Minn, United States) with Belzer MP solution (Trans Med, Elk River, Minn, United States). Donor age was 39.8 +/- 15.7 years. Terminal creatinine level was 1.45 +/- 0.8 mg/dL. Two of 15 were flushed in situ with HTK solution (no starch). Cold ischemia time was 28.8 +/- 9.1 hours with 14.3 +/- 5.1 hours of MP. In 13 of 15 patients, perfusion parameters were excellent (flow > 100 mL; resistance < .35). CHARACTERISTICS OF FP: Particles were 10-30 mu and globular in shape. FP were not visible on hematoxylin and eosin stain, but stained strongly periodic acid-Schiff-(PAS) positive and were refractile under polarized light. FP were seen segmentally within glomerular capillaries in all cases and in peritubular capillaries in 3. In 11 of the 15 cases with FP, focal glomerular fibrin thrombi or intracapillary neutrophil margination was seen. Ten of 15 patients with FP had a biopsy within the first week with no identifiable FP.
  
  
  RESULTS
  Recipient age was 45.3 +/- 11.6 years. Eight patients (53.3%) had delayed graft function. Biopsy-proven rejection occurred in 3 patients (20%). Three-month creatinine level was 1.59 +/- 0.35 mg/dL. One graft was lost to early thrombosis in a patient with a hypercoagulable state and 1 patient died of sepsis at 2 months. All remaining 13 patients are alive with excellent graft function at a median follow-up of 6.7 months (range, 3-17 months).
  
  
  CONCLUSIONS
  Microscopic intrarenal particles may be seen on DD kidney PRBx after MP. These FPs likely originate from surgical gloves. FPs are too small to be captured by standard filters but clear spontaneously and do not have deleterious effects on renal function or outcomes.
authors.affiliation: Division of Abdominal Organ Transplantation, New York Presbyterian Hospital, New York, New York, USA.
authors.forename: J V
authors.initials: JV
authors.lastname: Guarrera
authors.forename: S H
authors.initials: SH
authors.lastname: Nasr
authors.forename: C M
authors.initials: CM
authors.lastname: Reverte
authors.forename: B
authors.initials: B
authors.lastname: Samstein
authors.forename: T
authors.initials: T
authors.lastname: Brown
authors.forename: V
authors.initials: V
authors.lastname: Balachandran
authors.forename: M J
authors.initials: MJ
authors.lastname: Samuels
authors.forename: J
authors.initials: J
authors.lastname: Kelly
authors.forename: M A
authors.initials: MA
authors.lastname: Hardy
authors.forename: G S
authors.initials: GS
authors.lastname: Markowitz
authors.forename: V D
authors.initials: VD
authors.lastname: D'Agati
authors.forename: L E
authors.initials: LE
authors.lastname: Ratner
mesh_terms: D000328:Adult; D001706:Biopsy; D002102:Cadaver; D002241:Carbohydrates / Q000032:analysis; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000473:pathology; D006801:Humans; D007678:Kidney Glomerulus / Q000166:cytology / Q000648:ultrastructure; D016030:Kidney Transplantation / Q000473:pathology* / Q000502:physiology; D019520:Living Donors; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D002241:Carbohydrates; D003404:Creatinine