Background: Glomerular thrombosis of cadaveric kidneys usually occurred in donors with disseminated intravascular coagulation (DIC). DIC donors are frequently associated with open craniocerebral injury, massive blood transfusion and cardiopulmonary resuscitation. The transplant professionals may be unwilling to use these kidneys because of high rate of primary non-function. We studied the effect of machine perfusion with urokinase on kidneys with glomerular thrombosis.

Methods: Twelve kidneys from 6 DIC donors (5 cases of donation after brain death and 1 case of donation after cardiac death) were preserved by machine pulsatile perfusion with LifePort. Urokinase (2 × 105 units/L) was added into the KPS-1 solution. All kidneys showed extensive glomerular thrombosis on procurement biopsy. Wedge biopsies were repeated after perfusion.

Results: Causes of donor death included closed head trauma in 3, open head trauma in 2 and anoxia in 1. The terminal serum creatinine level was 409 ± 230 μmol/L (149 -816μmol/L) and the final 24-hour urine volume was 3284 ± 1460 mL(1200 - 5480mL). Twelve kidneys were transplanted and no case of hematoma occurred. The rate of glomerular thrombosis was 28.4% ± 7.1% (19.4% - 41.9%) on procurement biopsy, it was decreased to 12.8% ± 4.8% (6.1% - 20.0%) after machine perfusion and thrombolytic treatment. After a follow-up of 6 - 28 months, all renal graft survived. The estimated glomerular filtration rate (by the Modification of Diet in Renal Disease equation) of renal grafts at 3, 6 and 12 months were 33.9 ± 5.9, 37.7 ± 5.4 and 38.8 ± 6.9 ml/min/1.73m2, respectively.

Conclusions: Pre-treatment with machine perfusion and urokinase seems to be effective for kidneys with massive glomerular thrombosis. But the function of the renal grafts after thrombolytic treatment seems to be suboptimal.