Related Experiment Video
Updated: Apr 16, 2026
Murine Kidney Transplant Technique
Published on: October 20, 2015
Donor kidney microthrombi and outcomes of kidney transplant: a single-center experience
Puneet Sood1, Parmjeet S Randhawa, Rajil Mehta
1Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Abstract:
The kidney wait list has outgrown the supply of available organs every year. Efforts are being made to minimize discard rate of organs. One such area is the use of kidneys with glomerular microthrombi (MT). We retrospectively examined graft/patient outcomes in 28 cases with MT in pre-implantation biopsies. All patients had follow-up of at least 36 months, or until graft loss or death. In total, 17 of the 18 patients who underwent follow-up biopsy within 90 days of transplantation had cleared all MT. Most patients had excellent long-term graft function. On a closer review of the biopsies included in our study, we found that even in the organs with the most widespread thrombosis, the median percentage of glomeruli with more than 50 percentage of the capillary loops occluded was 8% (range 0-17%). The current practice of mentioning the % of glomeruli with thrombi cannot adequately capture the extent of donor organ pathology, as the actual % glomerular area involved can vary greatly from case to case. Future studies should attempt to quantify donor thrombi by a more robust method and revisit the issue of using clinico-pathologic parameters to predict allograft function in the setting of MT.
Insights
Kidneys with glomerular microthrombi (MT) can be successfully transplanted. Most patients cleared MT post-transplant, showing excellent long-term kidney graft function, suggesting MT may not preclude transplantation.
Area of Science:
- Nephrology
- Transplantation immunology
- Pathology
Background:
- The kidney organ waitlist exceeds available donor organs annually.
- Minimizing organ discard is crucial for transplantation.
- Glomerular microthrombi (MT) in donor kidneys present a challenge for utilization.
Purpose of the Study:
- To evaluate graft and patient outcomes in kidney transplants utilizing organs with pre-implantation glomerular microthrombi (MT).
- To assess the resolution of MT and long-term allograft function in recipients.
Main Methods:
- Retrospective analysis of 28 kidney transplant cases with MT in pre-implantation biopsies.
- Follow-up of at least 36 months or until graft loss/death.
- Review of follow-up biopsies within 90 days post-transplantation.
Main Results:
- 17 out of 18 patients with follow-up biopsies cleared all MT within 90 days.
- The majority of patients demonstrated excellent long-term kidney graft function.
- Even in severe cases, the median percentage of glomeruli with >50% capillary loop occlusion was only 8%.
Conclusions:
- Kidneys with glomerular microthrombi can yield favorable transplant outcomes.
- MT resolution is common post-transplantation, with good long-term graft function.
- Current methods for quantifying MT may underestimate donor organ pathology; improved quantification is needed.
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