GLOMERULAR ENDOTHELIAL-CELL DETACHMENT IN PAIRED CADAVER KIDNEY-TRANSPLANTS - EVIDENCE THAT SOME CADAVER DONORS HAVE PREEXISTING ENDOTHELIAL INJURY

Poor initial function is common in cadaveric renal transplantation, an d is usually attributed to acute tubular necrosis (ATN) brought about by ischemia during harvesting/implantation. However, this is often an assumption rather than a specific diagnosis. Recently, in 4 kidneys fr om 2 cadaver donors, we found evidence of severe endothelial injury, p rior to exposure to cyclosporine or other known endothelial toxins. Th e biopsies at the time of completion of the transplant revealed appare nt loss of glomerular endothelial cells on light microscopy, correspon ding on electron microscopy to shrinkage of the endothelial cells away from the basement membranes of the capillary loops. Extensive microva scular thrombi were present. All 4 grafts displayed impaired initial f unction, which partially recovered with time. The finding of these unu sual lesions in both kidneys from each of 2 donors suggested donor fac tors, although the only factor common to both donors was massive brain disruption. Thus, in the differential diagnosis of poor initial funct ion in kidneys transplanted from cadaver donors, one should consider r enal endothelial injury, which could lead to microthrombus formation, abnormal vasomotion, and functional impairment in the transplant.