Francke Marith I, Clahsen-van Groningen Marian C, van den Bosch Thierry P P, Becker Jan U, Hesselink Dennis A
Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Erasmus MC Transplant Institute, Rotterdam, the Netherlands.
Transplant Direct. 2021 Jun 18;7(7):e717. doi: 10.1097/TXD.0000000000001158. eCollection 2021 Jul.
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.
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.
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.
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.
胆固醇栓塞综合征（CES）是导致原发性肾脏肾衰竭的一个罕见但已知的病因，但关于肾移植受者中的CES却知之甚少。本研究的目的是确定肾移植后CES的发病率、临床特征、组织病理学及预后。
通过检索本机构肾脏病科和病理科的数据库，确定移植肾和原发性肾脏（对照组）中的CES病例。回顾性收集临床资料。活检根据最新的2019年版班夫分类标准进行分类。其次，于2020年12月1日对Ovid MEDLINE、EMBASE、Cochrane对照试验中心注册库、谷歌学术和科学网进行了系统的文献检索。
在2006年1月1日至2018年12月31日期间接受移植的2350例肾移植受者中，有11例（0.47%）在因病因进行的活检中发现了CES（每人年发病率为0.0009例）。所有患者都有≥1个心血管危险因素，9名供者为扩大标准供者。诊断为CES的患者中有27.3%发生了移植肾丢失。8例有CES的移植肾活检也被归类为活检证实的急性排斥反应。移植肾活检显示有炎症迹象（动脉炎，n = 7；间质炎症，n = 5；肾小管炎，n = 7）。确定了1例原发性肾脏患有CES的患者。原发性肾脏活检仅显示动脉炎，被归类为孤立的“v”病变。文献检索得到188篇独特的文章，其中20篇被纳入。共报道了47例肾移植后CES病例。在所有肾移植活检中，胆固醇栓子的发现率<1%。在文献中描述的有CES的肾移植活检中，57.8%伴有炎症。
CES是肾移植失败的一个罕见原因，尽管CES的发病率可能被低估。CES可能会因伴有动脉炎而被误诊为排斥反应。
