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

González, Anna; Juega, Javier; Vázquez, C. Martínez; Hernández-Gallego, Alba; López, Dolores; Cañas, Laura; Bancu, Ioana; Bonet, Josep; Lauzurica, Ricardo

doi:10.1016/j.transproceed.2015.09.005

Cited by 5 publications

(8 citation statements)

References 3 publications

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“…Atheroemboli may arise from either donor or recipient vessels. Embolization of donor origin occurred early after transplantation, causing primary renal allograft failure, while cholesterol embolization from recipient causes a late chronic allograft dysfunction, which usually occurs years after transplantation in a stable graft [43,44]. CCE is an important and under-reported cause of renal allograft dysfunction and should be considered when either primary or late renal graft failure occurs [45].…”

Section: Clinic Presentationsmentioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

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Renal disease caused by cholesterol crystal embolism (CCE) occurs when cholesterol crystals become lodged in small renal arteries after small pieces of atheromatous plaques break off from the aorta or renal arteries and shower the downstream vascular bed. CCE is a multisystemic disease but kidneys are particularly vulnerable to atheroembolic disease, which can cause an acute, subacute, or chronic decline in renal function. This life-threatening disease may be underdiagnosed and overlooked as a cause of chronic kidney disease (CKD) among patients with advanced atherosclerosis. CCE can result from vascular surgery, angiography, or administration of anticoagulants. Atheroembolic renal disease has various clinical features that resemble those found in other kidney disorders and systemic diseases. It is commonly misdiagnosed in clinic, but confirmed by characteristic renal biopsy findings. Therapeutic options are limited, and prognosis is considered to be poor. Expanding knowledge of atheroembolic renal disease due to CCE opens perspectives for recognition, diagnosis, and treatment of this cause of progressive renal insufficiency.

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Section: Clinic Presentationsmentioning

confidence: 99%

Cholesterol Crystal Embolism and Chronic Kidney Disease

Bayliss

Zhuang

2017

IJMS

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“…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%).…”

Section: Prognosismentioning

confidence: 99%

“…7 Pathological Findings Pathology findings are summarized in Table 5. Cholesterol emboli are most commonly found in interlobular arteries 7,16,18,23,24,28,32 and arcuate arteries. 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%).…”

Section: Prognosismentioning

confidence: 99%

“…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.…”

Section: Prognosismentioning

confidence: 99%

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

Francke

Groningen

Bosch

et al. 2021

Transplantation Direct

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“…The source of CCs may be donor or recipient vessels 65. CES of donor origin usually occurs early after transplantation, leading to primary allograft failure; however, CES of recipient origin usually occurs years after transplantation, causing chronic allograft dysfunction 66,67. CES of donor origin has been reported to have poorer prognosis 62…”

Section: Atheroembolic Renal Diseasementioning

confidence: 99%

<p>Cholesterol-embolization syndrome: current perspectives</p>

Özkök¹

2019

VHRM

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Cholesterol-embolization syndrome (CES) is a multisystemic disease with various clinical manifestations. CES is caused by embolization of cholesterol crystals (CCs) from atherosclerotic plaques located in the major arteries, and is induced mostly iatrogenically by interventional and surgical procedures; however, it may also occur spontaneously. Embolized CCs lead to both ischemic and inflammatory damage to the target organ. Therefore, anti-inflammatory agents, such as corticosteroids and cyclophosphamide, have been investigated as treatment for CES in several studies, with conflicting results. Recent research has revealed that CES is actually a kind of autoinflammatory disease in which inflammasome pathways, such as NLRP3 and IL1, are induced by CCs. These recent findings may have clinical implications such that colchicine and IL1 inhibitors, namely canakinumab, may be beneficial in the early stages of CES.

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

Cited by 5 publications

References 3 publications

Cholesterol Crystal Embolism and Chronic Kidney Disease

Cholesterol Crystal Embolism and Chronic Kidney Disease

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

<p>Cholesterol-embolization syndrome: current perspectives</p>

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