Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA.
Section of Transplant Nephrology, Department of Medicine, University of California, Davis Medical Center, Sacramento, CA.
Transplantation. 2019 Sep;103(9):1921-1927. doi: 10.1097/TP.0000000000002578.
Limited data are available on whether donor kidneys with diffuse glomerular fibrin thrombi (GFT) are safe to use. In this study, the clinicopathologic characteristics of allografts with diffuse donor-derived GFT were examined.
All deceased donor kidney transplant implantation biopsies from our institution between July 2011 and February 2018 with diffuse GFT were included. A control group for comparison consisted of all cases with implantation biopsies obtained during the study period without diffuse GFT. Clinical data were extracted from electronic medical records for all study patients, including donor information.
Twenty-four recipients received kidneys with diffuse GFT from 16 deceased donors. All donors died from severe head trauma. On average, 79% of glomeruli contained fibrin thrombi. Nineteen cases had subsequent biopsy; all revealed resolution of GFT. Compared with the control group, kidneys with diffuse GFT had longer cold ischemia time (34 versus 27 h), were more frequently pumped using machine perfusion (100% versus 81%), and recipients experienced a higher frequency of delayed graft function (58% versus 27%). Only 2 grafts with diffuse GFT failed within the first year. Overall graft survival was similar between the diffuse GFT group and control group.
Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor.
关于是否可以安全使用弥漫性供体肾小球纤维蛋白血栓（GFT）的供体肾脏，目前数据有限。在这项研究中，检查了所有弥漫性供体来源 GFT 的同种异体移植物的临床病理特征。
纳入了 2011 年 7 月至 2018 年 2 月期间我院所有弥漫性 GFT 移植植入活检的已故供体肾移植受者。对照组为研究期间所有无弥漫性 GFT 植入活检的病例。从电子病历中提取了所有研究患者的临床数据，包括供体信息。
24 例患者从 16 例已故供体接受了弥漫性 GFT 的供肾。所有供者均死于严重头部外伤。平均有 79%的肾小球含有纤维蛋白血栓。19 例进行了后续活检，所有病例的 GFT 均已消退。与对照组相比，弥漫性 GFT 供肾的冷缺血时间更长（34 小时比 27 小时），更频繁地使用机器灌注（100%比 81%），移植后延迟肾功能恢复的发生率更高（58%比 27%）。只有 2 例弥漫性 GFT 供肾在第一年就失败了。弥漫性 GFT 组和对照组的总体移植物存活率相似。
鉴于该队列中近 92%接受此类同种异体移植物的患者获得了良好的临床结果，因此，弥漫性 GFT 的已故供体肾脏似乎是安全的。组织学上，GFT 在移植后迅速消退。有趣的是，在该队列中，弥漫性 GFT 仅发生在头部遭受严重创伤的供体中，这可能是一个易患因素。
