1
|
Kute VB, Chauhan S, Prasad N, Meshram HS. A Narrative Review of Vaccine-Induced Thrombotic Thrombocytopenia in Organ Donation and Transplantation: Current Evidence and Implications. INDIAN JOURNAL OF TRANSPLANTATION 2023; 17:169-173. [DOI: 10.4103/ijot.ijot_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
|
2
|
Labbadia R, Diomedi Camassei F, Antonucci L, Guzzo I, Onetti Muda A, Spada M, Dello Strologo L. Reversible glomerular damage in disseminated intravascular coagulation. Pediatr Transplant 2022; 26:e14147. [PMID: 34585476 DOI: 10.1111/petr.14147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brain death secondary to traumatic brain injury is one of the main sources of organs for transplantation but it can be associated with disseminated intravascular coagulation, which has been considered a relative contraindication for kidney donation. METHODS We describe two successful pediatric cases of kidney transplantation from a single donor with disseminated intravascular coagulation. RESULTS A 17-year-old male donor died from head injury and both kidneys were offered to our center. Within 24 h, donor's Hb and platelets dropped to 8.3 g/dl and 32 000/mcl, respectively, serum creatinine reached 2.01 mg/dl, and urinalysis showed proteinuria (300 mg/dl). Pre-implant biopsy showed massive occlusion of glomerular capillaries by fibrin thrombi containing fragmented red blood cells and inflammatory cells, and acute tubular damage. Arterioles and small arteries were spared. A diagnosis of DIC was made. The kidneys were transplanted in a 16-year-old girl and a 13-year-old boy. Slow recovery of graft function was observed in both recipients. On post-operative day 3, platelets dropped to a minimum value of 66 000 and 86 000/mcl, respectively. Diuresis was always present. On day 4, platelets started to rise. Six months later, both recipients attained normal renal function. A six-month protocol biopsy showed no microthrombi or other signs of disseminated intravascular coagulation. CONCLUSIONS Despite the limited data available in literature, the outcome of these two cases is positive. Thus, pre-implant kidney biopsy, even if it reveals massive thrombotic occlusion of glomerular capillaries compatible with diagnosis of disseminated intravascular coagulation, should not be considered an absolute contraindication to transplantation.
Collapse
Affiliation(s)
- Raffaella Labbadia
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | | | - Luca Antonucci
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Isabella Guzzo
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | | | - Marco Spada
- Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Luca Dello Strologo
- Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| |
Collapse
|
3
|
Loupy A, Goutaudier V, Jacquelinet C, Kerbaul F. Solid organ procurement and transplantation from deceased donors with vaccine-induced thrombosis and thrombocytopenia. Am J Transplant 2021; 21:4098-4101. [PMID: 34233058 PMCID: PMC8441882 DOI: 10.1111/ajt.16751] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Alexandre Loupy
- Université de ParisINSERMPARCC, Paris Translational Research Centre for Organ TransplantationParisFrance
| | - Valentin Goutaudier
- Université de ParisINSERMPARCC, Paris Translational Research Centre for Organ TransplantationParisFrance
| | | | | |
Collapse
|
4
|
Xu L, Yin W, Li G, Fang J, Zhang L, Liu L, Xiong Y, Wu J, Pan G, Ma J, Chen Z. Effect of disseminated intravascular coagulation on donation after citizens' death donor kidneys. Transl Androl Urol 2021; 10:1273-1278. [PMID: 33850761 PMCID: PMC8039612 DOI: 10.21037/tau-20-785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background To investigate the effect of disseminated intravascular coagulation (DIC) on donor kidney in donation after citizens’ death (DCD) donors. Methods The clinical and laboratory data of 159 DCD donors obtained by our center in 2018 were retrospectively analyzed. The DIC diagnosis was performed according to the Chinese DIC scoring system (CDSS). The donors were divided into two groups: DIC (+) and DIC (−). The difference between kidney rejection rate and zero puncture glomerular microthrombus formation rate were compared. Results Among the 159 DCD donors, 11 were discarded (accounting for 6.91%). The reasons for the discarded cases included 5 cases (3.14%) for moderate and severe glomerular microthrombus formation in the renal zero puncture pathology; 2 cases (1.26%) for glomerular sclerosis ratio over 50%; 2 cases (1.26%) for long-term low blood pressure before pregnancy and significantly increased serum creatinine level and no urine; 1 case (0.73%) for kidney stones and stagnant water; 1 case (0.63%) for malignant tumor. The donor rejection rate of the DIC (+) group was higher than that of the DIC (−) group, and the difference was statistically significant (P<0.05). Among all donors, 10 cases (6.29%) were found to have glomerular microthrombus at zero puncture, and the microthrombotic rate in the DIC (+) group was significantly higher than that in the DIC (−) group (P<0.05). Of the 10 microthrombotic donors, 5 donors with severe glomerular microthrombus were discarded. Conclusions Donor-induced DIC can easily cause renal glomerular microthrombus formation, and the donor kidney rejection rate has increased.
Collapse
Affiliation(s)
- Lu Xu
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Yin
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guanghui Li
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiali Fang
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lei Zhang
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Luhao Liu
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunyi Xiong
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jialin Wu
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guanghui Pan
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junjie Ma
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zheng Chen
- Organ Transplantation Center of the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
5
|
Garrouste C, Baudenon J, Gatault P, Pereira B, Etienne I, Thierry A, Szlavik N, Aniort J, Rabant M, Lambert C, Sayegh J, Oniszczuk J, Anglicheau D, Heng AE. No impact of disseminated intravascular coagulation in kidney donors on long-term kidney transplantation outcome: A multicenter propensity-matched study. Am J Transplant 2019; 19:448-456. [PMID: 29981217 DOI: 10.1111/ajt.15008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 01/25/2023]
Abstract
The diagnosis of disseminated intravascular coagulation (DIC) is often considered to be a contraindication to organ donation. The aim of this study was to evaluate the impact of DIC+ donors on kidney recipient (KR) evolution. We identified 169 KRs with DIC+ donation after brain death donors between January 1996 and December 2012 in 6 French transplant centers. Individuals were matched using propensity scores to 338 recipients with DIC- donors according to donor age and sex, whether expanded criteria for the donor existed, graft year, and transplantation center. After kidney transplantation, delayed graft function was observed in 28.1% of DIC+ KRs and in 22.8% of DIC- KRs (NS). Renal allograft survival at 1, 5, and 10 years was 94.5%, 89.3%, and 73.9% and 96.2%, 90.8%, and 81.3% in DIC+ KRs and DIC- KRs, respectively (NS). The median estimated glomerular filtration rate (eGFR) was similar between DIC+ and DIC- KRs at 3 months, 1 year, and 10 years: 45.9 vs 48.1 mL/min, 42.1 vs 43.1 mL/min, and 33.9 vs 38.1 mL/min, respectively. Delayed calcineurin inhibitor introduction or induction had no impact on delayed graft function rate or eGFR evolution at 10 years after transplantation in DIC+ KRs. Donor DIC did not seem to affect initial outcome, long-term graft function, or allograft survival.
Collapse
Affiliation(s)
- Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Baudenon
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Philippe Gatault
- Department of Nephrology and Clinical Immunology, CHRU de Tours, Tours, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Antoine Thierry
- Department of Nephrology Dialysis and Kidney Transplantation, CHU de Poitiers, Poitiers, France
| | - Nora Szlavik
- Pathology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Aniort
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marion Rabant
- Pathology Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céline Lambert
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Johnny Sayegh
- Department of Nephrology Dialysis and Kidney Transplantation, CHU d' Angers, Angers, France
| | - Julie Oniszczuk
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Elisabeth Heng
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| |
Collapse
|
6
|
Wang CJ, Tuffaha A, Phadnis MA, Mahnken JD, Wetmore JB. Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients. Ann Transplant 2018. [PMID: 29610451 PMCID: PMC6248282 DOI: 10.12659/aot.907397] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Whether slow graft function (SGF) represents an intermediate phenotype between immediate graft function (IGF) and delayed graft function (DGF) in kidney transplant recipients is unknown. Material/Methods In a retrospective cohort analysis of 1,222 kidney transplant recipients, we classified patients as having IGF, SGF, and DGF using two different schemas. SGF was defined as serum creatinine (Cr) ≥3.0 mg/dL by postoperative day 5 in Schema 1, and in Schema 2, SGF was defined as Cr >1.5 mg/dL plus a creatinine reduction ratio <20% between postoperative days 1 and 3. A complementary log-log model was used to examine the association of graft function with graft survival and patient survival. Results Mean age of study patients was 51.5±13.3 years, 59.9% were male, and 66.7% were white. In Schema 1, SGF and DGF were associated with comparable increases in risk of graft failure compared to IGF (hazard ratio (HR) 1.46, 95% confidence intervals (CI) 1.02–2.10 for SGF and HR 1.56, CI 1.11–2.22 for IGF); estimates were similar for Schema 2 (HR 1.52, CI 1.05–2.20 for SGF and HR 1.54, CI 1.10–2.17 for IGF). However, for mortality, outcomes for SGF were similarly to IGF, both SGF and IGF were associated with lower risk relative to DGF (HR 0.54, CI 0.36–0.80 for SGF in Schema 1; HR 0.58, CI 0.39–0.85 for SGF in Schema 2). Conclusions These findings suggest that SGF may be a marker for graft failure but not for mortality, and SGF may therefore represent a phenotype separate from IGF and DGF.
Collapse
Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ahmad Tuffaha
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA.,The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - James B Wetmore
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis, MN, USA
| |
Collapse
|
7
|
Successful Renal Transplantation of Deceased Donor Kidneys With 100% Glomerular Fibrin Thrombi and Acute Renal Failure Due to Disseminated Intravascular Coagulation. Transplantation 2017; 101:1134-1138. [DOI: 10.1097/tp.0000000000001386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
8
|
Heilman RL, Mathur A, Smith ML, Kaplan B, Reddy KS. Increasing the Use of Kidneys From Unconventional and High-Risk Deceased Donors. Am J Transplant 2016; 16:3086-3092. [PMID: 27172238 DOI: 10.1111/ajt.13867] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 01/25/2023]
Abstract
In this paper, we have reviewed the literature and report on kidney donors that are currently used at relatively low rates. Kidneys from donors with acute kidney injury (AKI) seem to have outcomes equivalent to those from donors without AKI, provided one can rule out significant cortical necrosis. Kidneys from donors with preexisting diabetes or hypertension may have marginally lower aggregate survival but still provide patients with a significant benefit over remaining on the wait list. The Kidney Donor Profile Index derives only an aggregate association with survival with a very modest C statistic; therefore, the data indicated that this index should not be the sole reason to discard a kidney, except perhaps in patients with extremely low estimated posttransplant survival scores. It is important to note that the Scientific Registry of Transplant Recipients models of risk adjustment should allay concerns regarding regulatory issues for observed outcomes falling below expectations. The successful utilization of kidneys from donation after cardiac death over the past decade shows how expanding our thinking can translate into more patients benefiting from transplantation. Given the growing number of patients on the wait list, broadening our approach to kidney acceptance could have an important impact on the population with end-stage renal disease. Many lives could be prolonged by carefully considering use of kidneys that are often discarded.
Collapse
Affiliation(s)
- R L Heilman
- Department of Medicine, Mayo Clinic, Phoenix, AZ.
| | - A Mathur
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - M L Smith
- Departments of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - B Kaplan
- Department of Medicine, Mayo Clinic, Phoenix, AZ
| | - K S Reddy
- Department of Surgery, Mayo Clinic, Phoenix, AZ
| |
Collapse
|
9
|
Revollo JY, Cuffy MC, Witte DP, Paterno F, Alloway RR, Woodle ES. Case Report: Hemolytic Anemia Following Deceased Donor Renal Transplantation Associated With Tranexamic Acid Administration for Disseminated Intravascular Coagulation. Transplant Proc 2016; 47:2239-42. [PMID: 26361688 DOI: 10.1016/j.transproceed.2015.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Long-term outcomes of kidney transplantation with organs from donors with disseminated intravascular coagulation (DIC) are comparable with those from other deceased donors. The use of tranexamic acid to impair fibrinolysis in the treatment of DIC is becoming increasingly frequent, particularly in the trauma setting. However, the effects of tranexamic acid on a transplanted kidney allograft are unknown. RESULTS We report 2 cases of kidney transplantation following administration of tranexamic acid to the donor prior to organ donation. Microthrombi were present in the renal allografts. Both recipients experienced clinically significant hemolytic anemia, which typically occurs at a very low frequency. CONCLUSIONS These cases illustrate a potential concern for the use of tranexamic acid in deceased kidney donors with DIC.
Collapse
Affiliation(s)
- J Y Revollo
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; Department of Pharmacy Services, B-069, Jackson Memorial Hospital, Miami, Florida, USA
| | - M C Cuffy
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - D P Witte
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - F Paterno
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - R R Alloway
- Division of Nephrology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - E S Woodle
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
| |
Collapse
|
10
|
Cho YJ, Wee JW, Kwon SH, Jeon JS, Noh H, Han DC, Song D, Jin SY. Delayed Graft Function Is Associated with Microvascular Thrombosis in a Donor with Disseminated Intravascular Coagulation. KOREAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.4285/jkstn.2016.30.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yun Ju Cho
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jee Wan Wee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soon Hyo Kwon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin Seok Jeon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyunjin Noh
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dong Cheol Han
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dan Song
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - So Young Jin
- Department of Pathology, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Sood P, Randhawa PS, Mehta R, Hariharan S, Tevar AD. Donor kidney microthrombi and outcomes of kidney transplant: a single-center experience. Clin Transplant 2015; 29:434-8. [PMID: 25740383 DOI: 10.1111/ctr.12539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 11/27/2022]
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.
Collapse
Affiliation(s)
- Puneet Sood
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | |
Collapse
|
12
|
Differing tales of two patients after receiving a kidney transplant from a donor with disseminated intravascular coagulation. Case Rep Transplant 2014; 2014:754256. [PMID: 25061532 PMCID: PMC4100278 DOI: 10.1155/2014/754256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/31/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022] Open
Abstract
In order to decrease the time on the deceased donor kidney wait list and to have more organs available, criteria for acceptable organs for transplant could be made less stringent. There are reports of successful recipient outcomes using kidney donors presenting with disseminated intravascular coagulation (DIC). We report a unique circumstance where two patients received kidneys from the same deceased donor who had DIC; one patient developed thrombotic microangiopathy (TMA) while the other did not. This difference in outcome may indicate that both donor and recipient factors contribute to the development of posttransplant TMA.
Collapse
|
13
|
Ghuge PP, Kute VB, Vanikar AV, Gumber MR, Gera DN, Patel HV, Shah PR, Modi PR, Shah VR, Trivedi HL. Successful renal transplantation from a brain-dead deceased donor with head injury, disseminated intravascular coagulation and deranged renal functions. Indian J Nephrol 2013; 23:448-51. [PMID: 24339525 PMCID: PMC3841515 DOI: 10.4103/0971-4065.120344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Deceased donors (DDs) with the brain death due to head injury are the major source of organs for transplantation. The incidence of post-head injury disseminated intravascular coagulation (DIC) ranges from 24% to 50%. Many centers do not accept organs from donors with DIC due to increased risk of primary graft non-function and/or high chances of morbidity/mortality. We performed two successful renal transplants from a DD with head injury with DIC and deranged renal function. One of the recipients developed transient thrombocytopenia, but there was no evidence of DIC or delayed graft functions in either of the recipients. Over a follow-up of 1 month, both are doing well with stable graft function and hematological profile. Thus, a carefully selected DD with severe DIC even with deranged renal function is not a contraindication for organ donation if other risk factors for primary non-function are excluded. This approach will also help in overcoming organ shortage.
Collapse
Affiliation(s)
- P P Ghuge
- Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Sibulesky L, Gohh R, Charpentier K, Morrissey P. Kidney Transplantation from Donors with Severe Disseminated Intravascular Coagulation. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/646310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Disseminated intravascular coagulation (DIC) is a syndrome characterized by massive formation of thrombin, which can lead to renal dysfunction or failure. Many transplant centers are reluctant to accept the kidneys from donors with DIC especially if renal dysfunction is present. We developed protocol of machine perfusion followed by tissue plasminogen activator (tPA) infusion in order to treat and evaluate DIC kidneys prior to transplantation. The kidneys were placed on machine preservation with tPA added to the perfusate prior to transplantation. Three kidneys were transplanted from two donors who sustained gunshot injuries to the brain. A biopsy at the time of organ recovery documented widespread fibrin thrombi in approximately 80% of the glomeruli. Serial biopsies showed interval improvement following machine perfusion and a normal appearing kidney three months after successful transplantation. The histological presence of DIC in a deceased organ donor, even if associated with renal dysfunction, is not a contraindication to renal transplantation. Machine perfusion and tPA infusions may contribute to the recovery and successful transplantation of such kidneys.
Collapse
Affiliation(s)
- Lena Sibulesky
- Division of Organ Transplantation, Rhode Island Hospital, Alpert Medical School, Brown University, 593 Eddy Street, APC 921, Providence, RI 02903, USA
| | - Reginald Gohh
- Division of Organ Transplantation, Rhode Island Hospital, Alpert Medical School, Brown University, 593 Eddy Street, APC 921, Providence, RI 02903, USA
| | - Kevin Charpentier
- Division of Organ Transplantation, Rhode Island Hospital, Alpert Medical School, Brown University, 593 Eddy Street, APC 921, Providence, RI 02903, USA
| | - Paul Morrissey
- Division of Organ Transplantation, Rhode Island Hospital, Alpert Medical School, Brown University, 593 Eddy Street, APC 921, Providence, RI 02903, USA
| |
Collapse
|
15
|
Matar AJ, Crepeau RL, Pathiraja V, Robson S, Fishman JA, Spitzer TR, Sachs DH, Huang CA, Duran-Struuck R. Effects of mobilization regimens in donors on outcomes of hematopoietic cell transplantation in miniature Swine. Comp Med 2012; 62:487-494. [PMID: 23561882 PMCID: PMC3527753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 04/29/2012] [Accepted: 07/11/2012] [Indexed: 06/02/2023]
Abstract
Toxicities and complications associated with hematopoietic cell transplantation currently limit this potentially curative therapy for malignant and nonmalignant blood disorders. Miniature swine provide a clinically relevant model for studies to improve posttransplantation outcomes. Miniature swine recipients of high-dose haploidentical hepatopoietic cell transplantation after reduced-intensity conditioning consisting of low-dose (100 cGy) total-body irradiation, partial T-cell depletion by using a CD3 immunotoxin, and a 45-d course of cyclosporine A typically successfully engraft without graft-versus-host disease. We recently observed broad variability in engraftment outcomes that correlates with the occurrence of adverse reactions in donors after cytokine treatment to mobilize hematopoietic progenitor cells from the bone marrow to the peripheral blood for collection. Haploidentical recipients (n = 16) of cells from donors remaining healthy during cytokine treatment engrafted with multilineage chimerism, did not develop graft-versus-host disease, and did not require any blood products. In comparison, identically conditioned recipients of cells from donors that had severe reactions during cytokine treatment had adverse outcomes, including the development of clinically significant thrombocytopenia requiring blood product support in 8 of 11 swine. Furthermore, all 11 recipients lost peripheral blood myeloid chimerism (indicating lack of engraftment of donor stem cells). These data suggest that posttransplantation complications in swine are influenced by the health status of the donor before and during the collection of hematopoietic cells by leukapheresis.
Collapse
Affiliation(s)
| | | | | | - Simon Robson
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jay A Fishman
- Infectious Disease Division, and Transplant Center, Massachusetts General Hospital
| | | | | | | | | |
Collapse
|