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CASE REPORT
Fat embolism: a rare cause of perioperative renal transplant dysfunction
  1. Jemima Scott1,
  2. Neil Collin2,
  3. Richard Baker3,
  4. Rommel Ravanan4
  1. 1Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
  2. 2Department of Radiology, Southmead Hospital, Bristol, UK
  3. 3Department of Orthopaedics, Southmead Hospital, Bristol, UK
  4. 4Richard Bright Renal Unit, Southmead Hospital, Bristol, UK
  1. Correspondence to Dr Jemima Scott, jemima.scott{at}nbt.nhs.uk

Summary

Fat embolism is a recognised complication of bony injury and orthopaedic surgery, commonly involving the long bones and pelvis. We report on the case of a 68-year-old renal transplant recipient who developed acute kidney injury following surgical stabilisation of metastatic carcinoma of the acetabulum and replacement of the proximal femur. A CT renal angiogram demonstrated a large fat embolus in the inferior vena cava (IVC) and left iliac veins below the level of IVC filter, with impaired renal perfusion. The risks of open or endovascular lipothrombectomy were felt to outweigh the potential benefits. The patient was managed with systemic anticoagulation and prepared for transplant failure. Subsequently, there was spontaneous improvement in urine output and 4 months postoperatively her transplant function had returned to her baseline level and this has remained stable at 1 year postsurgery.

  • urological cancer
  • orthopaedics
  • interventional radiology
  • renal transplantation
  • acute renal failure

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Footnotes

  • Contributors JS: was 1st author on this manuscript. NC: was involved in imaging and decision-making. RB: was the Orthopaedic Consultant who performed the surgery; provided advice regarding the details of the operation. RR: was the named Renal Consultant for the patient and contributed to the writing of the manuscript.

  • Funding National Institute for Health Research Trainees Coordinating Centre Academic Clinical Fellowship awarded to JS.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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