Cholesterol embolization in a renal graft

Cholesterol embolization into native kidneys has a dim prognosis for renal function and frequently leads to irreversible renal failure. Although uncommon, cholesterol embolization may also occur in renal allografts, particularly if either the recipient or the donor has prominent atherosclerosis. We report here on a case of a 65-yr-old man with cholesterol emboli in the renal allograft and delayed graft function. The recipient's arteria iliaca externa was a potential source because of heavy atherosclerosis. The patient was dialysis-dependent for two wk after transplantation. However, renal function improved, no cholesterol emboli were found in a second biopsy of the graft and serum creatinine is 260 micromol/L six months after the transplantation. In the case of primary renal non-function or dysfunction, cholesterol embolization must be considered in the differential diagnosis. If renal cholesterol embolization originates from the recipient, allograft survival is usually good. In contrast, if cholesterol embolization is of donor origin, graft dysfunction and subsequent graft loss are common. The reason for this difference may be the more extensive embolization developing in an atherosclerotic cadaver donor occurring during the organ procurement or the severe trauma leading to death.