Increased development of microthrombi and fibrin depositions in deceased donor kidney transplantation

T.A.J. van den Berg, M.C. van den Heuvel, J. Wiersema-Buist, J. Adelmeijer, S.J.L. Bakker, H. van Goor, T. Lisman, R.A. Pol

Wednesday 4 march 2020

14:20 - 14:30h at Joep Nicolas zaal

Parallel session: Parallel sessie IV – Basale abstracts

Background: Microthrombi and fibrin depositions in peritubular capillaries and glomeruli of the donor kidney may potentially lead to local perfusion disorders, and subsequently to deterioration of graft function. The primary aim of this study was to investigate how often, and when, these microthrombi and fibrin depositions occur. Second aim was to investigate whether different donor types and intraoperative heparinization of the recipient are associated with the development of microthrombi and fibrin depositions.

Methods: Two open-needle biopsies, at start anastomosis and after reperfusion, were obtained from 43 kidneys transplanted from 2005 to 2008. Immunohistochemical staining with antibodies for fibrin(ogen) was performed on paraffin-embedded sections. Microthrombi/mm² (MT/mm²) were scored by a trained nephropathologist and fibrin deposition was categorized as none, low, moderate or high.

Results: An significant increase in MT/mm² (0.45 [0–1.21] vs. 0 [0–0.45]) and generalized fibrin deposition (100% vs. 20% moderate/high) was observed in postreperfusion biopsies compared to pre-anastomosis biopsies. The same was observed for deceased donor kidneys compared to living donor kidneys (0.09 [0–0.66] vs. 0.00 [0–0], p=0.02). Administration of heparin prior to reperfusion, significantly reduces the number of MT/mm² (0.49[0-0.69] vs. 0 [0-0], p<0.01).

Conclusions: Kidney transplantation is related with the development of microthrombi and a generalized deposition of fibrin in peritubular capillaries and glomeruli. Deceased donor kidneys are more prone to this development. There may be a role for prophylactic heparinization of the recipient to inhibit this process.