ESPN 53rd Annual Meeting

ESPN 2021


 
Reversible glomerular graft damage in disseminated intravascular coagulation
RAFFAELLA LABBADIA 1 LUCA ANTONUCCI 4 FRANCESCA DIOMEDI CAMASSEI 2 LAURA LUCCHETTI 1 ISABELLA GUZZO 1 ANDREA ONETTI MUDA 2 MARCO SPADA 3 LUCA DELLO STROLOGO 1

1- NEPHROLOGY, DYALISIS AND RENAL TRANSPLANT UNIT BAMBINO GESù CHILDREN’S RESEARCH HOSPITAL IRCCS. ROME ITALY
2- PATHOLOGY UNIT BAMBINO GESù CHILDREN’S RESEARCH HOSPITAL IRCCS. ROME ITALY
3- ABDOMINAL TRANSPLANT SURGERY BAMBINO GESù CHILDREN’S RESEARCH HOSPITAL IRCCS. ROME ITALY
4- ACADEMIC DEPARTMENT OF PEDIATRICS UNIVERSITY OF ROME “TOR VERGATA”, NEPHROLOGY, DYALISIS AND RENAL TRANSPLANT UNIT BAMBINO GESù CHILDREN’S RESEARCH HOSPITAL IRCCS, ROME, ITALY
 
Introduction:

 

Kidneys from a 17-year-old male donor who died from head injury in a car accident were offered. His labs at ICU showed: fibrinogen 20 mg/dL, Hb 12 gr/dl, hematocrit 36.8% and platelets 237,000/mcl.CPK was 318 mg/dl with MB fraction of 6%. Serum creatinine was 0.9 mg/dL. Within 24 hours hematocrit, Hb and platelets dropped to 23.8%, 8.3 g/dl and 32,000/mcl, respectively. Serum creatinine rose to a maximum of 2.01 mg/dL and urinalysis showed proteinuria (300 mg/dL) at the time of organ procurement.

 

Material and methods:

Pre-implant kidney biopsy showed acute tubular damage; glomerular capillaries were massively occluded by fibrin thrombi containing fragmented red blood cells and inflammatory cells. Arterioles and small arteries were consistently spared. A diagnosis of disseminated intravascular coagulation (DIC) was made. Thrombotic microangiopathy was also considered, but the absence of significant vascular wall damage, despite massive microthrombi formation, made it less likely.

Results:

Kidneys were accepted. Delayed graft function was observed for both recipients until post-operative (pod) day 6. Platelets dropped to a minimum value of 65,000 and 84,000/mcl for each recipient on pod 6 and 5and were again above 200,000/mcl on pod 12 and 11. Diuresis was always present. Renal function improved quite slowly: creatinine clearance in the two children was 68  and 54 ml/min/1.73 m2on pod 30, 80 and 81 ml/min/1.73 m2  and 100 and 80 ml/min/1.73 m2  on 3th and 6th months after transplant, respectively.

Conclusions:

DIC occurs in 29% of potential donors and is a frequent cause for organ refusal.It consists ofpersistent coagulation activation and extensive formation of microthrombi in microvessels, especially in capillary bed. As DIC progresses, it can lead to multiorgan failure. Although renal recovery after transplantation is slow, kidneylesions are likelyreversible and do not affect long-term function of the transplanted organ. Such kidneys should therefore be considered for transplantation.