Novel Histopathologic and Ultrastructural Findings in Renal Allografts From Patients With Size and Age Mismatches: A Case Series

Abstract

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. Each of these cases exhibits unique changes seen in mismatched donorrecipient 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.

Structural and Histopathologic Changes in Renal Allografts from an Infant Donor

“…In analysis of renal allograft transplant, decline of kidney function is multifactorial. Potential loss of a renal allograft can include rejection or infection, but more subtle changes may occur in patients who receive an age, sex, or size-mismatched kidney [4]. In this report, we describe the case of a 20-year-old male receiving bilateral en bloc kidneys from a 9-month-old female.…”