Progressive interstitial fibrosis of kidney allograft early after transplantation from a non-heart beating donor: Possible role of persistent ischemic injury

Kohsuke Masutani, Hidehisa Kitada, Shunsuke Yamada, Akihiro Tsuchimoto, Hideko Noguchi, Kazuhiko Tsuruya, Ritsuko Katafuchi, Masao Tanaka, Mitsuo Iida

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

The donor was 63-yr-old woman with subarachnoid hemorrhage. As she developed severe hypotension for more than four h before cardiac arrest, we biopsied the grafts and decided to transplant those kidneys. Recipient 1 was a 23-yr-old man on 13-yr dialysis program. After 19 d of delayed graft function (DGF), we discontinued hemodialysis (HD). However, the decrease in serum creatinine (sCr) was poor. The minimum sCr was 4.3 mg/dL on post-operative day (POD) 40, and increased to 6.5 mg/dL. The contralateral graft was transplanted to a 61-yr-old man (recipient 2) with 18-yr HD. After 15 d of DGF period, sCr decreased gradually and has been stable at 1.9 mg/dL. In recipient 1, graft biopsies performed on POD 15, 69, and 110, revealed progressive interstitial fibrosis and tubular atrophy (IF/TA) without evidences of acute rejection, tacrolimus associated injury, reflux nephropathy, or viral nephropathy. The second biopsy on POD 69 showed typical findings of acute tubular necrosis. We compared the clinical courses of the two recipients because certain features of recipient 1, such as age, duration of HD, total ischemic time, and body size were advantageous, whereas graft function was poorer than that in recipient 2. Recipient 1 developed severe anemia following the dissociation of graft function from recipient 2. In this case, posttransplant anemia and lower blood pressure might promote IF/TA through persistent ischemic tubular damage, and positive CMV antigenemia and its treatment could promote anemia. Especially in the kidney allograft from a marginal donor, we should consider various factors to obtain a better graft outcome.

Original languageEnglish
Pages (from-to)70-74
Number of pages5
JournalClinical Transplantation
Volume24
Issue numberSUPPL. 22
DOIs
Publication statusPublished - Jul 1 2010

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Allografts
Fibrosis
Transplantation
Tissue Donors
Transplants
Kidney
Wounds and Injuries
Delayed Graft Function
Renal Dialysis
Anemia
Creatinine
Atrophy
Serum
Biopsy
Body Size
Tacrolimus
Subarachnoid Hemorrhage
Heart Arrest
Hypotension
Dialysis

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Progressive interstitial fibrosis of kidney allograft early after transplantation from a non-heart beating donor : Possible role of persistent ischemic injury. / Masutani, Kohsuke; Kitada, Hidehisa; Yamada, Shunsuke; Tsuchimoto, Akihiro; Noguchi, Hideko; Tsuruya, Kazuhiko; Katafuchi, Ritsuko; Tanaka, Masao; Iida, Mitsuo.

In: Clinical Transplantation, Vol. 24, No. SUPPL. 22, 01.07.2010, p. 70-74.

Research output: Contribution to journalArticle

Masutani, Kohsuke ; Kitada, Hidehisa ; Yamada, Shunsuke ; Tsuchimoto, Akihiro ; Noguchi, Hideko ; Tsuruya, Kazuhiko ; Katafuchi, Ritsuko ; Tanaka, Masao ; Iida, Mitsuo. / Progressive interstitial fibrosis of kidney allograft early after transplantation from a non-heart beating donor : Possible role of persistent ischemic injury. In: Clinical Transplantation. 2010 ; Vol. 24, No. SUPPL. 22. pp. 70-74.
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