Assessment and Management of Transplant Renal Artery Stenosis. A Literature Review

Pini, Alessia; Faggioli, Gianluca; Pini, Rodolfo; Mauro, Raffaella; Gallitto, Enrico; Mascoli, Chiara; Grandinetti, Valeria; Donati, Gabriele; Odaldi, Federica; Ravaioli, Matteo; Gargiulo, Mauro

doi:10.1016/j.avsg.2022.01.011

Cited by 8 publications

(5 citation statements)

References 64 publications

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“…However, multiple case series and reviews have described the effectiveness of percutaneous transluminal angioplasty stenting, especially if a drug-eluting stent were used. 4 The present case represents a rare event of transplant RAT combined with external iliac artery thrombosis.…”

Section: Discussionmentioning

confidence: 78%

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Urgent endovascular maneuvers to rescue a failing transplant kidney with a T-stent approach

Cavenaghi¹,

Cappiello²,

Pini³

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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Section: Discussionmentioning

confidence: 78%

“… 3 At present, two of the main causes of transplant loss are high-grade stenosis of the renal artery and thrombosis. 4 , 5 Renal artery stenosis can afflict ≤20% of transplanted kidneys. In contrast, renal artery thrombosis (RAT) is a rare event, affecting 0.5% to 3.5%.…”

mentioning

confidence: 99%

Urgent endovascular maneuvers to rescue a failing transplant kidney with a T-stent approach

Cavenaghi¹,

Cappiello²,

Pini³

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…As far as is currently understood, complications following renal transplantation are uncommon, with dissection of the graft renal artery being particularly rare. In the event that it does occur, balloon dilatation or surgery is the treatment of preference, which is usually performed after months of observation (5)(6)(7)(8). We documented a case in which the graft renal artery was dissected at an extremely early stage; stenting was effectively executed, yielding favorable results during the follow-up periods for both inpatients and outpatients.…”

Section: Discussionmentioning

confidence: 99%

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Vu,

Nguyen,

Nguyen

et al. 2024

Front. Cardiovasc. Med.

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BackgroundTransplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.Case presentationA 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months.ConclusionsTransplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.

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“…TRAS can be successfully and safely treated through an endovascular approach. Stent delivery seems to guarantee a higher patency rate compared to simple angioplasty; however, further studies are needed to confirm these results [ 36 ]. Transplant renal artery and vein thrombosis have an early onset and a dramatic clinical manifestation and usually lead to allograft loss.…”

Section: Ceus Role For Transplant Kidney Complicationsmentioning

confidence: 99%

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications

et al. 2022

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Renal transplantation (RT) is the treatment of choice for end-stage renal disease, significantly improving patients’ survival and quality of life. However, approximately 3–23% of patients encounter post-operative complications, and radiology plays a major role for their early detection and treatment or follow-up planning. CT and MRI are excellent imaging modalities to evaluate renal transplant post-operative course; nevertheless, they are both associated with a high cost and low accessibility, as well as some contraindications, making them not feasible for all patients. In particular, gadolinium-based contrast can lead to the rare condition of nephrogenic systemic fibrosis, and iodine-based contrast can lead to contrast-induced nephropathy (CIN). CT also exposes the patients who may require multiple examinations to ionizing radiation. Therefore, considering the overall advantages and disadvantages, contrast-enhanced ultrasound (CEUS) is presently considered an effective first-line imaging modality for post-operative early and long-term follow-up in RT, reducing the need for biopsies and providing adequate guidance for drainage procedures. Hence, this paper aims to review the updated knowledge on CEUS compared with CT and MRI for the evaluation of RT renal transplant complications; advantages, limitations, and possible recommendations are provided.

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Assessment and Management of Transplant Renal Artery Stenosis. A Literature Review

Cited by 8 publications

References 64 publications

Urgent endovascular maneuvers to rescue a failing transplant kidney with a T-stent approach

Urgent endovascular maneuvers to rescue a failing transplant kidney with a T-stent approach

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications

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