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Abstract: SA-PO878

Case Series of Donor-Recipient Renal Transplant Mismatches: Looking Beyond the Size?

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • 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

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).


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
CaseDonor AgeRecipient AgeGender MismatchTime to BxUA at time of BxDiagnosisT-cell Infiltrate
15d60y?96dHematuriaImmature Glomeruli15%
214y33yYes65dOliguria with seroma
Thin GBM Disease<10%