Pliquett Rainer U, Asbe-Vollkopf Aida, Scheuermann Ernst H, Gröne Elisabeth, Probst Michael, Geiger Helmut, Hauser Ingeborg A
J Med Case Rep. 2009 Mar 26;3:6839. doi: 10.1186/1752-1947-3-6839.
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.
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. 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/1.73m(2) and 23.9 ml/min/1.73m(2), and remained stable in follow-up examinations. Possible donor and surgical procedure-dependent causes for cholesterol-crystal embolism are discussed.
Cholesterol-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.
已故供体肾功能受损和/或存在动脉粥样硬化会增加肾移植受者发生移植肾功能延迟恢复和长期肾功能受损的风险。
我们报告了两名肾移植受者同时发生移植肾功能延迟恢复的情况，这两名受者年龄分别为57岁和39岁，接受了来自同一名已故供体的肾脏移植。62岁的供体在哮喘发作期间死于心脏骤停。由于移植肾功能延迟恢复，对两名肾移植受者均进行了肾移植活检，结果显示存在胆固醇结晶栓塞。除低剂量阿司匹林外，还开始了经验性他汀类药物治疗。在分别每48小时进行10次和6次血液透析后，两个肾移植均开始发挥功能。出院时的肾小球滤过率分别为26 ml/min/1.73m(2)和23.9 ml/min/1.73m(2)，在随访检查中保持稳定。讨论了胆固醇结晶栓塞可能的供体和手术相关原因。
胆固醇结晶栓塞应被视为移植肾功能延迟恢复和肾移植长期功能受损的一个原因，尤其是在老年供体人群中。
