JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B

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Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?

Author(s): Yamei CHENG, Luying GUO, Xue REN, Zhenzhen YANG, Junhao LV, Huiping WANG, Wenhan PENG, Hongfeng HUANG, Jianyong WU, Jianghua CHEN, Rending WANG
Affiliation(s): Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more
Corresponding email(s): rd_wangjia@zju.edu.cn
Key Words: Deceased donor; Delayed graft function; Microthrombi; Thrombocytopenia; Thrombotic microangiopathy

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Yamei CHENG, Luying GUO, Xue REN, Zhenzhen YANG, Junhao LV, Huiping WANG, Wenhan PENG, Hongfeng HUANG, Jianyong WU, Jianghua CHEN, Rending WANG. Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?[J]. Journal of Zhejiang University Science B,in press.Frontiers of Information Technology & Electronic Engineering,in press.https://doi.org/10.1631/jzus.B2200451

@article{title="Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?",
author="Yamei CHENG, Luying GUO, Xue REN, Zhenzhen YANG, Junhao LV, Huiping WANG, Wenhan PENG, Hongfeng HUANG, Jianyong WU, Jianghua CHEN, Rending WANG",
journal="Journal of Zhejiang University Science B",
year="in press",
publisher="Zhejiang University Press & Springer",
doi="https://doi.org/10.1631/jzus.B2200451"
}

%0 Journal Article
%T Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?
%A Yamei CHENG
%A Luying GUO
%A Xue REN
%A Zhenzhen YANG
%A Junhao LV
%A Huiping WANG
%A Wenhan PENG
%A Hongfeng HUANG
%A Jianyong WU
%A Jianghua CHEN
%A Rending WANG
%J Journal of Zhejiang University SCIENCE B
%P 524-529
%@ 1673-1581
%D in press
%I Zhejiang University Press & Springer
doi="https://doi.org/10.1631/jzus.B2200451"

TY - JOUR
T1 - Outcomes of allograft from donor kidney microthrombi and secondary recipient thrombotic microangiopathy: should we consider loosening the belt?
A1 - Yamei CHENG
A1 - Luying GUO
A1 - Xue REN
A1 - Zhenzhen YANG
A1 - Junhao LV
A1 - Huiping WANG
A1 - Wenhan PENG
A1 - Hongfeng HUANG
A1 - Jianyong WU
A1 - Jianghua CHEN
A1 - Rending WANG
J0 - Journal of Zhejiang University Science B
SP - 524
EP - 529
%@ 1673-1581
Y1 - in press
PB - Zhejiang University Press & Springer
ER -
doi="https://doi.org/10.1631/jzus.B2200451"

Abstract
Chinese Summary
Academic Network
Reviewer Comment

Abstract: There is currently a huge worldwide demand for donor kidneys for organ transplantation. Consequently, numerous marginal donor kidneys, such as kidneys with microthrombi, are used to save patients’ lives. While some studies have shown an association between the presence of microthrombi in donor kidneys and an increased risk for delayed graft function (DGF) (McCall et al., 2003; Gao et al., 2019), other studies have demonstrated that microthrombi negatively impact the rate of DGF (Batra et al., 2016; Hansen et al., 2018), but not graft survival rate (McCall et al., 2003; Batra et al., 2016; Gao et al., 2019). In contrast, Hansen et al. (2018) concluded that fibrin thrombi were not only associated with reduced graft function six months post-transplantation but also with increased graft loss within the first year of transplantation. On the other hand, Batra et al. (2016) found no significant differences in the DGF rate or one-year graft function between recipients in diffuse and focal microthrombi groups. To date, however, the overall influence of donor kidney microthrombi and the degree of influence on prognosis remain controversial, necessitating further research.

供体肾微血栓和继发性受体血栓性微血管病对同种异体移植肾的影响：我们应该放松警惕吗？

程雅妹^1,2,3,4,5，郭陆英^1,2,3,4,5，任雪^1,2,3,4,5，杨珍珍^1,2,3,4,5，吕军好^1,2,3,4,5，王慧萍^1,2,3,4,5，彭文翰^1,2,3,4,5，黄洪锋^1,2,3,4,5，吴建永^1,2,3,4,5，陈江华^1,2,3,4,5，王仁定^1,2,3,4,5
¹浙江大学医学院附属第一医院肾脏病中心，中国杭州市，310003
²浙江省肾脏病防治技术研究重点实验室，中国杭州市，310003
³国家临床重点专科，中国杭州市，310003
⁴浙江大学肾脏病研究所，中国杭州市，310003
⁵浙江省肾脏与泌尿系统疾病临床创医学研究中心，中国杭州市，310003
摘要: 为评估死亡供肾血栓和其诱导的受体血栓性微血管病（dir-TMA）对受体移植肾功能的影响，我们回顾性分析了33例活检病理显示微血栓的供体信息及受体预后。根据血栓累及肾小球范围是否大于50%，将33例供体分为弥漫血栓组（n=18）和局灶血栓组（n=15）。结果显示，弥漫血栓组的移植物延迟复功（DGF）发生率显著高于局灶血栓组（P=0.027），肾移植术后1个月，肾小球滤过率（eGFR）估值水平显著低于局灶血栓组（P=0.042）。此外，根据受体是否发生了dir-TMA，将33例受体进一步分为dir-TMA组（n=20）和non-dir-TMA组（n=13）。结果显示，dir-TMA 组受体肾移植术后0至9天的血小板和术后4天至1年的血红蛋白明显低于non-dir-TMA组；dir-TMA受体的DGF发生率高于non-dir-TMA组（50.0% vs. 15.4%，P=0.067），且肾移植术后1月、3月、6月和12月的肾功能均显著差于non-dir-TMA组。此外，根据受体是否接受血浆治疗，将20例发生dir-TMA的受体分为血浆治疗亚组和无血浆治疗亚组。分析表明，血浆治疗亚组受体在移植术后1月、3月、6月和12个月的肾功能均显著差于无血浆治疗亚组。综上，供肾弥漫血栓会增加受体DGF风险，但不影响移植肾功能。临床需关注发生dir-TMA受体的血小板和血红蛋白下降及肾功能恶化，有必要采用更多研究用以评估血浆疗法的效果。

关键词组：供肾血栓；血栓性微血管病；血小板减少；死亡供体；肾移植

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Reference

[1]ÁvilaA, GavelaE, SanchoA, 2021. Thrombotic microangiopathy after kidney transplantation: an underdiagnosed and potentially reversible entity. Front Med, 8:642864.

[2]BatraRK, HeilmanRL, SmithML, et al., 2016. Rapid resolution of donor-derived glomerular fibrin thrombi after deceased donor kidney transplantation. Am J Transplant, 16(3):1015-1020.

[3]GaoGF, ChenLX, BrownIE, et al., 2019. Donor characteristics, recipient outcomes, and histologic findings of kidney allografts with diffuse donor-derived glomerular fibrin thrombi. Transplantation, 103(9):1921-1927.

[4]GarrousteC, BaudenonJ, GataultP, et al., 2019. No impact of disseminated intravascular coagulation in kidney donors on long-term kidney transplantation outcome: a multicenter propensity-matched study. Am J Transplant, 19(2):448-456.

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[9]PasturalM, BarrouB, DelcourtA, et al., 2001. Successful kidney transplantation using organs from a donor with disseminated intravascular coagulation and impaired renal function: case report and review of the literature. Nephrol Dial Transplant, 16(2):412-415.

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[13]WangCJ, ShafiqueS, MccullaghJ, et al., 2011. Implications of donor disseminated intravascular coagulation on kidney allograft recipients. Clin J Am Soc Nephrol, 6(5):1160-1167.

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供体肾微血栓和继发性受体血栓性微血管病对同种异体移植肾的影响：我们应该放松警惕吗？

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Reference