Glomerular fibrin thrombi in ABO and crossmatch compatible renal allograft biopsies

Megan Troxell, Douglas Norman, Anuja Mittalhenkle

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Glomerular fibrin thrombi may be an early indication of antibody-mediated rejection in renal allograft biopsies. However, fibrin thrombi have a broad differential; thus, we sought to evaluate the etiology and implications of glomerular fibrin thrombi in allograft biopsies of blood group and cytotoxic crossmatch compatible renal allografts.Biopsies were identified from the pathology files of Oregon Health & Science University. Detailed histopathologic findings were retrospectively correlated with clinical data, treatment, and outcome.Sixteen early posttransplant biopsies had glomerular fibrin thrombi, including three surveillance biopsies. Six of 16 biopsies had no other histopathologic findings; 5/16 had glomerulitis and peritubular capillaritis; 4/16 had concomitant cellular vascular rejection; one had parenchymal infarction. C4d staining was positive in 4/16 cases. Most patients were treated with IVIg and plasmapheresis, others with rapamycin, thymoglobulin, or rituximab. At an average follow-up of 62 months, 8 patients with functioning grafts had a mean serum creatinine of 1.4. mg/dL (122 μmol/L).Antibody-mediated rejection is an important consideration in blood group compatible allograft biopsies with glomerular fibrin thrombi, even with C4d-negative biopsies. However, multidisciplinary evaluation is necessary, given other etiologies, including drug toxicity, hemolytic-uremia syndrome, and large vessel thrombosis. Despite aggressive treatment, both short and long-term graft survival may be compromised.

Original languageEnglish (US)
Pages (from-to)15-23
Number of pages9
JournalPathology Research and Practice
Volume207
Issue number1
DOIs
StatePublished - Jan 15 2011

Fingerprint

Fibrin
Allografts
Thrombosis
Kidney
Biopsy
Blood Group Antigens
Plasmapheresis
Antibodies
Uremia
Graft Survival
Sirolimus
Drug-Related Side Effects and Adverse Reactions
Infarction
Blood Vessels
Creatinine
Pathology
Staining and Labeling
Transplants
Health
Serum

Keywords

  • Acute allograft rejection
  • C4d
  • Calcineurin inhibitor toxicity
  • Fibrin thrombi
  • Thrombotic microangiopathy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Cell Biology

Cite this

Glomerular fibrin thrombi in ABO and crossmatch compatible renal allograft biopsies. / Troxell, Megan; Norman, Douglas; Mittalhenkle, Anuja.

In: Pathology Research and Practice, Vol. 207, No. 1, 15.01.2011, p. 15-23.

Research output: Contribution to journalArticle

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