Reversible glomerular damage in disseminated intravascular coagulation.

Area of Science:

• Nephrology
• Transplantation Surgery
• Hematology

Background:

• Traumatic brain injury leading to brain death is a primary source for organ donation.
• Disseminated intravascular coagulation (DIC) is a condition often associated with brain death and has historically been a contraindication for kidney donation.
• Limited data exists on the viability of transplanting kidneys from donors with DIC.

Observation:

• A 17-year-old male donor with DIC underwent kidney donation following head trauma.
• Pre-implant biopsy revealed significant glomerular capillary occlusion by fibrin thrombi, indicative of DIC.
• Despite these findings, the donor kidneys were transplanted into two pediatric recipients (16-year-old female, 13-year-old male).

Findings:

• Both pediatric recipients showed slow but steady recovery of graft function.
• Recipient platelet counts temporarily decreased post-transplant but began to rise by post-operative day 4.
• Six months post-transplantation, both recipients achieved normal renal function.
• Protocol biopsies at six months showed no evidence of microthrombi or ongoing DIC.

Implications:

• Pre-implant kidney biopsy findings of DIC, including thrombotic occlusion, should not be an absolute contraindication for kidney transplantation.
• Successful pediatric kidney transplantation from a donor with DIC demonstrates the potential to expand the donor pool.
• These cases suggest that careful patient selection and monitoring may allow for successful transplantation in select DIC cases.