Key result
Electron microscopy revealed severe endothelial dysfunction of renal microvasculature in two cases of early kidney graft loss where light microscopy found no significant pathology.
Why the study?
Does electron microscopy detect severe endothelial dysfunction of renal microvasculature missed by light microscopy in deceased donor kidney grafts?
Case Report (n=2)
Does electron microscopy detect severe endothelial dysfunction of renal microvasculature missed by light microscopy in deceased donor kidney grafts?
Electron microscopy may be necessary to detect severe endothelial dysfunction in kidney grafts from donors with conditions like prolonged ECMO or Takotsubo cardiomyopathy, which can lead to early graft loss.
Alerts clinicians to possible occult endothelial injury in early graft loss; hypothesis-generating and leaves open routine electron microscopy use.
Decision process about the acceptance of the deceased donor kidney for transplantation might be challenging. Although histological evaluation of pretransplant donor kidney biopsy provides reliable information regarding cortical necrosis, vascular thrombosis, extensive global glomerulosclerosis, and interstitial fibrosis/tubular atrophy, only electron microscopy enables thorough and reliable insights into microvasculature changes of kidney graft. The aim of the present paper is to briefly present two cases of early kidney graft loss. In one case, the donor was exposed to long-term extracorporeal membrane oxygenation (ECMO); in the other case, the donor experienced Takotsubo cardiomyopathy. In both cases, light microscopy of pretransplant biopsy found no pathology or significant discrepancy in morphology of kidney graft, while electron microscopy revealed severe endothelial dysfunction of renal microvasculature. Our results suggest that severe injury of renal microvasculature with relatively preserved tubular epithelium may be associated with some conditions of deceased kidney donors leading to early kidney graft nonfunction and loss. Further studies are needed to determine prognostic significance of severe ultrastructural microvasculature lesions and to evaluate disease states and conditions that could be associated with severe endothelial dysfunction of kidney graft.
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Kojc et al. (2018) conducted a case report in Early kidney graft loss (n=2). Electron microscopy of pretransplant biopsy vs. Light microscopy was evaluated on Endothelial dysfunction of renal microvasculature. Electron microscopy revealed severe endothelial dysfunction of renal microvasculature in two cases of early kidney graft loss where light microscopy found no significant pathology.
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