Cholesterol-crystal embolism presenting with delayed graft function and impaired long-term function in renal transplant recipients: two case reports

Rainer U Pliquett,Michael Probst,Helmut Geiger,Aida Asbe-Vollkopf,Elisabeth Gröne,Ingeborg A Hauser,Ernst H Scheuermann

doi:10.1186/1752-1947-3-6839

Abstract

IntroductionImpaired renal function and/or pre-existing atherosclerosis in the deceased donor increase the risk of delayed graft function and impaired long-term renal function in kidney transplant recipients.Case presentationWe report delayed graft function occurring simultaneously in two kidney transplant recipients, aged 57-years-old and 39-years-old, who received renal allografts from the same deceased donor. The 62-year-old donor died of cardiac arrest during an asthmatic state. Renal-allograft biopsies performed in both kidney recipients because of delayed graft function revealed cholesterol-crystal embolism. An empiric statin therapy in addition to low-dose acetylsalicylic acid was initiated. After 10 and 6 hemodialysis sessions every 48 hours, respectively, both renal allografts started to function. Glomerular filtration rates at discharge were 26 ml/min/1.73m2 and 23.9 ml/min/1.73m2, and remained stable in follow-up examinations. Possible donor and surgical procedure-dependent causes for cholesterol-crystal embolism are discussed.ConclusionCholesterol-crystal embolism should be considered as a cause for delayed graft function and long-term impaired renal allograft function, especially in the older donor population.

Highlights

Impaired renal function and/or pre-existing atherosclerosis in the deceased donor increase the risk of delayed graft function and impaired long-term renal function in kidney transplant recipients.Case presentation: We report delayed graft function occurring simultaneously in two kidney transplant recipients, aged 57-years-old and 39-years-old, who received renal allografts from the same deceased donor
Impaired renal function and/or pre-existing atherosclerosis or prevalent cardiovascular risk factors in the deceased donor increase the risk for delayed graft function (DGF) and impaired
We report two kidney recipients with DGF and impaired longterm renal function who received renal allografts from the same donor

Summary

Introduction

The acceptance of older and marginal donors has become necessary. We report two kidney recipients with DGF and impaired longterm renal function who received renal allografts from the same donor. In both cases, renal transplant biopsies were performed on day 13 post-transplant revealing cholesterol-crystal embolism (CCE). Glomerular filtration rate (GFR) leveled off at 26 ml/min/ 1.73 m2 and 23.9 ml/min/1.73m2 by discharge, and remained stable at a reduced level in follow-up examinations (Figure 1) Both kidney recipients had arterial hypertension as comorbidity. The warm kidney ischemia period was 46 and 65 minutes, and cold kidney ischemia lasted for 11 hours 40 minutes and 19 hours 6 minutes Both patients received quadruple immunosuppression consisting of a calcineurin inhibitor, prednisone and mycophenolate mofetil in addition to induction therapy with an interleukin-2 receptor antagonist. Prednisone therapy was given as immunosuppression, and a potential therapeutic role for CCE has been proposed [4]

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Meyrier A