Kidney Transplantation From a Donor With Acute Kidney Injury: An Unexpected Outcome

Surgery was uneventful, but kidney function did not recover. A pretransplant graft biopsy sample processed shortly after surgery showed acute tubular necrosis with microvascular thrombosis (Figure 1A and B). Despite unfractionated heparin infusion, serum creatinine levels did not improve. On day 6, a second transplant biopsy again showed fresh microthrombi in approximately 30% of glomeruli, without signs of rejection (Figure 1C and D). One hundred milligrams of recombinant tissue plasminogen activator were infused, followed by subcutaneous injection of 100U/kg of enoxaparin twice daily. After a transient improvement in kidney perfusion and function, serum creatinine progressively increased and the patient resumed hemodialysis in July 2006. The explanted graft disclosed chronic allograft nephropathy. A subsequent deceased-donor transplant was uneventful.

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