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

Authors :
Marian C. Clahsen-van Groningen
Thierry P P van den Bosch
Dennis A. Hesselink
Jan Becker
Marith I. Francke
Internal Medicine
Pathology
Source :
Transplantation Direct, Vol 7, Iss 7, p e717 (2021), Transplantation Direct, Transplantation Direct. Wolters Kluwer Health
Publication Year :
2021

Abstract

Supplemental Digital Content is available in the text.<br />Background. Cholesterol embolization syndrome (CES) is an uncommon but well-known cause of renal failure in native kidneys, but little is known about CES in kidney transplant recipients. The aim of this study was to determine the incidence, clinical characteristics, histopathology, and prognosis of CES after kidney transplantation. Methods. CES cases in both transplanted and native kidneys (control group) were identified by searching the databases of the divisions of Nephrology and Pathology of our institution. Clinical data were retrospectively collected. Biopsies were classified according to the latest Banff 2019 Update. Second, a systematic literature search was performed (December 01, 2020) of Ovid MEDLINE, EMBASE, the Cochrane Central Register of controlled trials, Google Scholar, and Web of Science. Results. CES was observed in for-cause biopsies of 11 out of 2350 (0.47%) kidney transplant recipients transplanted between January 1, 2006, and December 31, 2018 (0.0009 cases per person-year). All patients had ā‰„1 cardiovascular risk factor, and 9 donors were expanded criteria donors. Graft loss occurred in 27.3% of the patients diagnosed with CES. Eight transplant biopsies with CES were also classified as biopsy-proven acute rejection. Transplant biopsies showed signs of inflammation (arteritis, n = 7; interstitial inflammation, n = 5; tubulitis, n = 7). One patient with CES in a native kidney was identified. The biopsy of the native kidney only showed arteritis and classified as an isolated ā€œvā€ lesion. The literature search resulted in 188 unique articles of which 20 were included. A total of 47 cases of CES after kidney transplantation was reported. Cholesterol emboli were found in

Details

ISSN :
23738731
Volume :
7
Issue :
7
Database :
OpenAIRE
Journal :
Transplantation direct
Accession number :
edsair.doi.dedup.....0c17fa4df4b982cd0b8213a81fc84006