Universität zu Köln

Francke, Marith I., Clahsen-van Groningen, Marian C., van den Bosch, Thierry P. P., Becker, Jan U. and Hesselink, Dennis A. (2021). Cholesterol Embolization Syndrome After Kidney Transplantation: A Case Series and Systematic Review. Transplant. Direct., 7 (7). PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 2373-8731

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Abstract

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 >= 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 v 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 <1% of all kidney transplant biopsies. In 57.8% of the kidney transplant biopsies with CES described in literature, concomitant inflammation was present. Conclusions. CES is an uncommon cause of kidney transplant failure, although the incidence of CES may be underestimated. CES may mimic rejection as it can be accompanied by arteritis.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Francke, Marith I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Clahsen-van Groningen, Marian C. UNSPECIFIED UNSPECIFIED UNSPECIFIED van den Bosch, Thierry P. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Jan U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hesselink, Dennis A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-570631
DOI:	10.1097/TXD.0000000000001158
Journal or Publication Title:	Transplant. Direct.
Volume:	7
Number:	7
Date:	2021
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	2373-8731
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ALLOGRAFT DYSFUNCTION; RENAL-TRANSPLANTATION; EMBOLIC DISEASE; GRAFT; PATIENT; VASCULITIS Multiple languages Transplantation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57063