Abstract: SA-PO1035
Donor-Derived Disseminated Intravascular Coagulation in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Author
- Subramanian, Nivetha, Stanford University School of Medicine, Stanford, California, United States
Introduction
Hemolysis is estimated to affect 9-40% of solid organ transplant recipients. Potential etiologies range from passenger lymphocyte syndrome from minor ABO incompatibilities to medication (i.e. calcineurin inhibitor related) thrombotic microangiopathies (TMA). Disseminated intravascular coagulation (DIC) transmitted from donor to recipient is an uncommon and underrecognized cause of post-transplant hemolysis. Here is a case of an individual who acquired DIC from a donor following kidney transplantation.
Case Description
Patient A is a 60 year old gentleman with end-stage kidney disease (ESKD) from IgA nephropathy. He received a deceased donor kidney with immediate graft function. Immediate post-transplant labs are notable for anemia (hemoglobin 6 g/dL from 11 pre-transplant), thrombocytopenia (30 K/uL from 168 pre-transplant), LDH 1300 U/L, haptoglobin < 30, elevated unconjugated bilirubin, 2+ shistocytes on peripheral smear and negative direct coomb’s broad spectrum, elevated d-dimer 7.60, fibrinogen 206, INR 1.0, PTT of 33.1. Tacrolimus was held and he was supported with several blood and platelet transfusions. Further investigation revealed that the recipient of the second kidney from the same donor, transplanted after Patient A, also developed a similar consumptive coagulopathy with hemolysis, though with a less severe clinical presentation. Overall, labs improved in both patients after several days of supportive care and tacrolimus was safely restarted. Review of donor data revealed low-grade DIC.
Discussion
Donor-derived DIC is a rare but important consideration in the differential diagnosis of post-transplant hemolysis. While DIC in a donor is not a contraindication to organ donation, some studies have reported an increased risk of delayed graft function. Conversely, other studies have shown that long-term allograft outcomes may remain favorable. The proposed mechanism for transmission includes transmission of inflammatory cytokines that trigger DIC or expression of tissue factors on endothelial cells. Typically, donor-derived DIC follows a self-limiting course. Both recipients currently have stable kidney function and no recurrence of hemolysis.