We transplanted a kidney from a deceased donor last week. The kidney was slow to recover in one of the recipients (we received both kidneys) and that recipient was biopsied. The pathology showed renal phospholipidosis. Our pathologist was wondering about Fabry disease. I suppose we could do genetic testing on the renal biopsy. The donor had no known Fabry. But suppose the donor was a mosaic, would the kidney be at risk from low alpha-gal activity? I’m assuming the kidney will recover from the ATN, but would there be a role for enzyme replacement afterwards if the kidney does have Fabry phenotype?