Table of Contents
ISRN Transplantation
Volume 2013, Article ID 646310, 4 pages
http://dx.doi.org/10.5402/2013/646310
Research Article

Kidney Transplantation from Donors with Severe Disseminated Intravascular Coagulation

Division of Organ Transplantation, Rhode Island Hospital, Alpert Medical School, Brown University, 593 Eddy Street, APC 921, Providence, RI 02903, USA

Received 31 December 2012; Accepted 30 January 2013

Academic Editors: W. Lim, J. M. Rebibou, A. Rydzewski, and M. Veroux

Copyright © 2013 Lena Sibulesky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Disseminated intravascular coagulation (DIC) is a syndrome characterized by massive formation of thrombin, which can lead to renal dysfunction or failure. Many transplant centers are reluctant to accept the kidneys from donors with DIC especially if renal dysfunction is present. We developed protocol of machine perfusion followed by tissue plasminogen activator (tPA) infusion in order to treat and evaluate DIC kidneys prior to transplantation. The kidneys were placed on machine preservation with tPA added to the perfusate prior to transplantation. Three kidneys were transplanted from two donors who sustained gunshot injuries to the brain. A biopsy at the time of organ recovery documented widespread fibrin thrombi in approximately 80% of the glomeruli. Serial biopsies showed interval improvement following machine perfusion and a normal appearing kidney three months after successful transplantation. The histological presence of DIC in a deceased organ donor, even if associated with renal dysfunction, is not a contraindication to renal transplantation. Machine perfusion and tPA infusions may contribute to the recovery and successful transplantation of such kidneys.