Successful Utilization of Kidney Allografts with Diffuse Glomerular Fibrin Thrombi on the Preimplantation Biopsy after Circulatory Death: A Case Series

Background: Kidney allografts with the presence of diffuse glomerular fibrin thrombi are typically rejected by most centers due to concern for poor allograft outcomes in the recipients. The aim of this study was to report our single center experience in the use of such deceased donor allografts. Methods: Retrospective single-center cohort study of kidney transplant recipients who received deceased donor allografts with moderate-to-severe diffuse glomerular fibrin microthrombi on the pre-implantation biopsy. Results: Three adult recipients received deceased donor kidney transplantation from donation after circulatory death donors. One patient was pre-emptive to dialysis at the time of transplant. The donors had moderate-to-severe diffuse glomerular fibrin thrombi on preimplantation biopsies with no evidence of cortical necrosis. Mean follow-up period was 196 days. None of the recipients developed delayed allograft function. The mean 3-month and 6-month creatinine were 1.6 and 1.5 mg/dL, respectively, with corresponding mean eGFRs (estimated glomerular filtration rates) of 45.7 and 47.3 mL/min/1.73m2. Conclusions: After excluding significant cortical necrosis by experienced transplant renal pathologist, otherwise transplantable kidney allografts with diffuse fibrin thrombi may be successfully transplanted in renal transplant recipients with good renal outcomes.