Cholesterol embolization and severe vascular rejection in a renal allograft recipient

Cholesterol embolization (CE) is a well-known cause of renal dysfunction, often leading to irreversible renal failure most often in elderly patients. However, because of its unspecific and subclinical appearance, CE is often misdiagnosed. As donors and recipients of increasing age or with prominent atherosclerotic disease are accepted for transplantation, CE in renal allografts may become more prevalent. Here, we report a case of a 31-year-old second renal allograft recipient with CE as a cause of early graft failure, followed by severe vascular rejection, eventually requiring nephrectomy.