Two cases of primary non‐functioning kidney from the same donor

Abstract

Abstract: We report two cases of primary non‐functioning kidney from the same non‐heart beating donor (NHBD). A 42‐yr‐old man received a renal transplant from a NHBD. The donor was a 38‐yr‐old male who died of neck spinal injury. The warm ischemic time was 61 min. One h after reperfusion, the graft became edematous and congested in the presence of normal and adequate vascular anastomosis and lack of renal vein thrombosis. The one‐h biopsy specimen showed acute tubular necrosis and severe congestion with occasional platelet aggregates in glomerular capillaries. The graft was resected on post‐transplantation day 6. Graftectomy specimen revealed renal cortical necrosis. The contralateral kidney of the same donor was transplanted into a 54‐yr‐old male. The one‐h biopsy specimen showed tubular degeneration and neutrophil infiltration in peritubular capillaries, but no glomerular congestion or thrombus. The recipient died on post‐transplantation day 4. Although the cause of death was unknown, necropsy of the renal graft showed renal cortical necrosis, similar to case 1. Ischemia/reperfusion injury was considered the cause of non‐functioning kidney in both cases, because of long warm ischemic time. The biopsy specimens at zero‐h from both grafts showed focal tubular degeneration only without distinct necrosis, indicating it is difficult to predict viability based on the pathological findings at zero‐h or one‐h biopsies. There is a need for further understanding of clinical and histological patterns in order to define the criteria of viability of kidney transplant.