Cholesterol atheroembolic disease in kidney allografts – case report and review of the literature

Cholesterol embolization in a renal graft

“…Cholesterol embolic disease is probably an under‐reported cause of renal allograft dysfunction. As the current tendency is to accept older donors and recipients with more advanced atherosclerotic disease, this condition is likely to become more frequent in the future (9). Our case was the second after more than 900 renal transplantations in our center.…”

Cholesterol Embolization Syndrome After Kidney Transplantation: A Case Series and Systematic Review

“…Kidney transplant loss occurred in 21 out of the 45 cases (46.7%) described in literature. 7,8,[14][15][16]22,23,25,[27][28][29][30][31]33 However, in at least 6 of these cases (13.3%), transplant loss was probably not caused by CES. 7,28,33 In studies that described >2 CES cases (ie, after the exclusion of case reports), 7 out of 23 grafts failed (30.4%).…”

“…7,16,18,[28][29][30] In 19 biopsies studied by Lai et al, 7 cholesterol emboli were found in interlobular arteries in 14 cases (73.7%) and in arcuate arteries in 2 (10.5%). Concomitant histological findings were tubular atrophy and necrosis, 7,8,[15][16][17]24,[26][27][28][32][33][34] nephrosclerosis, 8,24 inflammation or cellular infiltrate, [14][15][16][17][18]24,32,33 hyaline changes, 8,23,27 negative C4d staining, 23,24 fibrous intimal thickening, 14,32,33 and interstitial fibrosis (Table 5). 8,27 None of the articles investigated histological similarities between CES and vascular type rejection in kidney transplants or how to differentiate between these 2 diagnoses.…”

Atheroembolic renal disease

“…76,77 So far, only 45 cases have been reported-too few to defi ne the natural history of the disorder. [76][77][78][79][80][81][82][83][84][85] Such disease is probably underestimated because of the use of small needles for taking biopsy samples and sampling error. Atheroemboli causing injury to the renal allograft can arise from either the donor or the recipient vessels.…”