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Abstract: SA-PO860

Green Donor Kidneys: Transplantable or Not

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Me, Hay Me, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Budhiraja, Pooja, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Sukumaran Nair, Sumi, Mayo Clinic Arizona, Scottsdale, Arizona, United States
  • Kodali, Lavanya, Mayo Clinic Arizona, Scottsdale, Arizona, United States

Hyperbilirubin cause detrimental effects on kidney tubule function. In ongoing organ shortage, utilization of high-risk donor kidneys is needed. The outcomes of transplanting donor kidneys with bile cast nephropathy is uncertain.

Case Description

A pair of deceased kidneys were offered from a 34-year-old male with history of cirrhosis of liver with portal hypertension secondary to alcohol dependent disorder. He had acute kidney injury (AKI) requiring continuous renal replacement therapy. His liver function tests were elevated including total bilirubin of 40.5 mg/dl and direct bilirubin of 20 mg/dl. Both kidneys had greenish discoloration in appearance (Fig 2). Renal biopsy on frozen section showed minimal interstitial fibrosis, moderate arterial sclerosis, moderate tubular injury. The right kidney was transplanted into a 67-year-old female with end stage renal disease (ESRD) from renal cell carcinoma and the left kidney was transplanted to a 64-year-old female with ESRD from hypertension. Cold ischemic time were 22 hours 40 minutes and 30 hours and 9 minutes, respectively. Post reperfusion renal pathology was consistent with bile cast nephropathy and acute tubular injury (Fig 1). Both kidneys had delayed graft function and required hemodialysis for 29 days and 22 days respectively. By second month, both creatinine improved to 1.6-1.8 mg/dl.


Our case report indicates that kidneys from donors with cholemic nephropathy, even with severe AKI can be safely utilized. Although it is associated with delayed graft function in immediate post-transplant period, there is significant improvement by the second month.

Donor Kidneys

Bile Cast Nephropathy