Transplanting Kidneys with Acute Renal Failure and Myoglobinuria; Clinical Correlation and Immuno-Histopathological Findings
JM Gonzalez-Berjon, LD Truong, R Barrios, RJ Knight, S Patel, LW Gaber. The Methodist Hospital, Houston, TX
Background: Organ shortage has led to the use of kidneys from donors with impaired renal function. There is limited experience in utilizing kidneys with rhabdomyolysis and little information about the incidence of myoglobinuria in deceased donor kidneys used for transplantation. Histological features of kidney biopsies from myoglobinuric donors and their clinical significance remain largely unclear.
Design: We reviewed 103 immediate post implantation kidney biopsies (within 30 to 60 minutes after revascularization of the allograft) that were obtained since January of 2009. All biopsies (n=15) with features of acute tubular injury (ATI) were reevaluated for the presence of myoglobinuria by immunohistochemistry (IHC). We identified those cases with myoglobinuric ATI (M-ATI; n=5) and classified the remaining cases and by donor source into deceased donor with ATI (DD-ATI; n= 4) and living donor kidneys with ATI (LRD-ATI; n=6).
Results: Myoglobinuric casts in the M-ATI group were coarsely granular and bright eosinophilic; varying degrees of acute tubular cell necrosis were also seen. There were numerous interstitial and some intratubular cells that stained positive for Mib-1 demonstrating high level of proliferative activity. Delay graft function (DGF) was found in 4 of 5 patients from the M-ATI group and 2 of 4 of DD-ATI group. Slow graft function was found in 1 patient from the M-ATI group, 2 from the DD-ATI group as well as 2 patients from the LDR/LTI group. 4 of 6 patients from the LDR/ATI group have immediate graft function. In DD-ATI patients IHC demonstrated the presence of occult myoglobin casts in 4 of the 4 biopsies with minimal findings consistent with ischemic ATN. Living donor kidneys had no demonstrable myoglobin casts. There were no kidney losses in any group of patients.
Conclusions: Rhabdomyolysis appears to be among the acute reversible causes of ATI in donor kidney biopsies and should not contraindicate the use of these kidneys. Myoglobinuria may be more common in transplanted kidneys with ATN than previously recognized. Preliminary data here rendered suggest that more subtle forms of myoglobinuria detected only by myoglobin IHC stain may have a role in early graft dysfunction. Additional research in this topic is warranted to further understand the impact of myoglobinuria in the transplant setting.
Category: Kidney (does not include tumors)
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 231, Wednesday Afternoon