Renal Transplant Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy.
Pathology, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy.
Pediatr Transplant. 2022 Feb;26(1):e14147. doi: 10.1111/petr.14147. Epub 2021 Sep 28.
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.
We describe two successful pediatric cases of kidney transplantation from a single donor with disseminated intravascular coagulation.
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.
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.
创伤性脑损伤导致的脑死亡是器官移植的主要来源之一，但可能伴有弥散性血管内凝血，这被认为是肾脏捐献的相对禁忌症。
我们描述了两例成功的弥散性血管内凝血儿童供肾移植病例。
一名 17 岁男性供者因头部受伤死亡，其双肾均被提供给我们中心。在 24 小时内，供者的血红蛋白和血小板分别降至 8.3 g/dl 和 32000/mcl，血清肌酐达到 2.01 mg/dl，尿液分析显示蛋白尿（300 mg/dl）。移植前活检显示大量纤维蛋白血栓阻塞肾小球毛细血管，其中含有破碎的红细胞和炎症细胞，以及急性肾小管损伤。小动脉和小动脉未受累。诊断为弥散性血管内凝血。这对肾脏被移植到一名 16 岁女孩和一名 13 岁男孩体内。两名受者的移植物功能均缓慢恢复。术后第 3 天，血小板降至最低值分别为 66000 和 86000/mcl。尿量始终存在。第 4 天，血小板开始上升。6 个月后，两名受者均获得正常肾功能。6 个月的方案活检显示无微血栓或弥散性血管内凝血的其他迹象。
尽管文献中提供的资料有限，但这两个病例的结果是积极的。因此，即使移植前肾脏活检显示大量符合弥散性血管内凝血诊断的肾小球毛细血管血栓性闭塞，也不应被视为移植的绝对禁忌症。
