Abstract: SA-PO878
Case Series of Donor-Recipient Renal Transplant Mismatches: Looking Beyond the Size?
Session Information
- Transplantation: Clinical - Case Reports
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Lilley, Cullen M., Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
- Picken, Maria M., Loyola University Health System, Maywood, Illinois, United States
Introduction
While reports on the long-term pathology in mismatched allografts have been focused on the donor and recipient body surface area, evidence is emerging to support donor-recipient age difference as an additional prognostic factor. Most reports are based on pediatric recipients receiving older/bigger allografts. Here, we describe three cases with age mismatch including two cases of adult patients receiving pediatric allografts and a third case of a younger patient receiving an allograft from an older donor exhibiting findings not described in extant literature (Table 1).
Case Description
Case 1: a 60-year-old (y) female with history of hypertensive nephrosclerosis (HNS) received bilateral kidneys en block from a 5-day-old donor. Subsequently, stent-related hydronephrosis and hematuria developed. Biopsy showed persistent immature glomeruli. Case 2: a 33y male with history of HNS received one kidney from a 14y female donor. He developed perinephric seroma, oliguria and hematuria; biopsy revealed thin glomerular basement membrane disease. Case 3: a 21y female with ESRD of an unknown etiology received en block bilateral kidneys from a 74y female donor. Post-surgery one allograft required nephrectomy owing to necrosis. Subsequently, non-nephrotic proteinuria developed and allograft biopsy showed focal & segmental glomerulosclerosis (Fig. 1A) with podocyte effacement and GBM multilayering with Alport-like changes (Fig. 1B). None of these patients exhibited T-cell or antibody-mediated rejection (Table 1).
Discussion
Each of these cases exhibit unique changes seen in mismatched donor-recipient size/age post-transplant pathology. These non-rejection changes should be suspected in cases of donor-recipient size/age mismatch. In cases of allograft function decline, a full biopsy workup, including electron microscopy, should be considered.
Summary of Cases
| Case | Donor Age | Recipient Age | Gender Mismatch | Time to Bx | UA at time of Bx | Diagnosis | T-cell Infiltrate |
| 1 | 5d | 60y | ? | 96d | Hematuria | Immature Glomeruli | 15% |
| 2 | 14y | 33y | Yes | 65d | Oliguria with seroma hematuria | Thin GBM Disease | <10% |
| 3 | 74y | 21y | No | 1057d | Proteinuria | FSGS-Alport-like | <5% |