title: 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 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.
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain.
authors.forename: A P
authors.initials: AP
authors.lastname: González
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Juega
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Vazquez
authors.affiliation: Department of Pathological Anatomy of the University Hospital "Germans Trias I Pujol", Badalona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Hernández-Gallego
authors.affiliation: Department of Pathological Anatomy of the University Hospital "Germans Trias I Pujol", Badalona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: López
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain; REDinREN 12/0021/0027, Fundación Jiménez Díaz Hospital, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Cañas
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Bancu
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain; REDinREN 12/0021/0027, Fundación Jiménez Díaz Hospital, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bonet
authors.affiliation: Nephrology Department of the University Hospital "GermansTrias I Pujol", Badalona, Spain; REDinREN 12/0021/0027, Fundación Jiménez Díaz Hospital, Madrid, Spain. Electronic address: rlauzurica.germanstrias@gencat.cat.
authors.forename: R
authors.initials: R
authors.lastname: Lauzurica
mesh_terms: D000368:Aged; D017700:Embolism, Cholesterol / Q000473:pathology*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000473:pathology*; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D019737:Transplants / Q000098:blood supply* / Q000473:pathology