Late Onset of Cholesterol Embolism Leading to Graft Failure After Renal Transplantation: Report of Two Cases

Abstract Cholesterol-crystal embolization (CE) usually presents as an acute or subacute multisystemic disease. When affecting native kidneys prognosis is poor, often leading to chronic kidney disease. Presentation in renal allografts is a rare condition although probably underdiagnosed. If renal CE...

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Bibliographic Details
Published in:Transplantation proceedings 2015-10, Vol.47 (8), p.2361-2363
Main Authors: González, A.P, Juega, J, Vazquez, C, Hernández-Gallego, A, López, D, Cañas, L, Bancu, I, Bonet, J, Lauzurica, R
Format: Article
Language:English
Subjects:
Aged
Embolism, Cholesterol - pathology
Graft Rejection
Graft Survival
Humans
Kidney - blood supply
Kidney - pathology
Kidney Failure, Chronic - surgery
Kidney Transplantation
Male
Postoperative Complications - pathology
Risk Factors
Surgery
Tissue Donors
Transplantation, Homologous
Transplants - blood supply
Transplants - pathology
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Summary:Abstract Cholesterol-crystal embolization (CE) usually presents as an acute or subacute multisystemic disease. When affecting native kidneys prognosis is poor, often leading to chronic kidney disease. Presentation in renal allografts is a rare condition although probably underdiagnosed. If renal CE originates from the recipient, allograft survival is usually good, whereas if the donor is the origin, graft dysfunction and subsequent graft loss are common. Associated risk factors are common to native and transplanted kidneys. We report 2 renal graft recipients of different cadaveric donors, both male and 68 years old, diagnosed with CE in renal grafts at 19 and 72 months after transplantation, respectively. They presented previous risk factors for CE, including severe atherosclerosis. They presented insidious and asymptomatic impairment of renal function initially. Renal graft biopsy specimens showed CE in the interlobular arteries. Potential triggers for CE were suspended and high doses of steroids were started. However, progressive decline in renal function and requirement of chronic dialysis occurred within the first year after diagnosis in both cases. Herein we discuss the causal or incidental role of CE in the graft failure of these cases, highlighting the serious outcome despite the recipient origin of the CE and the initiation of treatment.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2015.09.005