Fibromuscular dysplasia of the allograft renal artery with early post-operative dissection: successful treatment with intravascular stent insertion

Vérove, C.; Bridoux, Frank; Abou-Ayache, Ramzi; Bauwens, Marc; Drouineau, J; Touchard, Guy

doi:10.1093/ndt/14.6.1571

Cited by 11 publications

(9 citation statements)

References 4 publications

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“…After a follow up of 3 years the recipient had still not developed Renal Transplantation for FMD We found five reports concerning grafts from deceased donors without a history of hypertension in which significant postoperative stenosis attributed to FMD occurred (Table 1; Refs. 18,[23][24][25][26]. In these recipients hypertension could be controlled with conventional methods.…”

Section: Discussionmentioning

confidence: 99%

Renal Transplantation for Fibromuscular Dysplasia

Knops¹,

Cornelissen²,

Monnens

2011

American Journal of Transplantation

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This is the first report that presents renal transplantation after bilateral nephrectomy as the final treatment for severe renovascular hypertension due to fibromuscular dysplasia (FMD). We describe the history of a 1-year-old girl who suffered from renovascular hypertension due to FMD. Imaging revealed multiple bilateral stenoses of the renal artery extending into the distal branches. The hypertension proved unresponsive to pharmacologic treatment and the intrarenal peripherally located stenoses rendered a conventional approach such as transluminal or surgical angioplasty not feasible. At the age of 5 years, a unilateral nephrectomy of the most affected kidney was performed, but she remained hypertensive and developed progressive cardiomyopathy and retinopathy. At the age of 6 years the remaining kidney was removed, followed by a living related renal transplantation with a kidney donated by her mother. Posttransplantation, she developed mild hypertension due to a postanastomotic stenosis, which was easily controlled with antihypertensives. Now 8 years after transplantation, she has experienced no further blood pressure related problems. Although there is a risk of recurrence of FMD after performing a living related transplantation, our report suggests that this procedure is relatively safe, provided appropriate preoperative evaluation and follow up is performed.

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Section: Discussionmentioning

confidence: 99%

Renal Transplantation for Fibromuscular Dysplasia

Knops¹,

Cornelissen²,

Monnens

2011

American Journal of Transplantation

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“…There have been few reports on TRAS caused by TRAD. TRAD is an uncommon condition usually associated with percutaneous transluminal angioplasty, arteriosclerotic disease, and fibromuscular dysplasia [8][9][10]. Allograft function after TRAD can possibly be saved with appropriate treatment, including surgical revascularization or stent implantation; therefore, early recognition and diagnosis are really important.…”

Section: Discussionmentioning

confidence: 99%

Unexpected presentation and surgical salvage of transplant renal artery dissection caused by vascular clamping: a case report

et al. 2020

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Background: Transplant renal artery dissection is a rare and serious event that can cause allograft dysfunction and activation of the renin-mediated renovascular hypertension. Most cases are induced by percutaneous transluminal angioplasty, arteriosclerotic disease, or fibromuscular dysplasia. We observed a case of transplant renal artery dissection induced by unusual causes during kidney transplantation. Case presentation: A 35-year-old woman, whose mother donated a kidney to her, underwent ABO-incompatible living kidney transplantation. The allograft had one renal artery and vein that were anastomosed to the internal iliac artery and external iliac vein, respectively. Although careful handling was performed in all procedures including vascular clamping, Doppler ultrasonography (US) immediately after reperfusion showed an increase in the systolic blood velocity and urine output was not observed. Arterial anastomotic stenosis was suspected, but upon exploration, a renal artery dissection was detected in the middle portion of the donor artery. The part of the transplant renal artery was resected, and cold reflux was started again. At the resected part of transplant renal artery, dissection was identified. After re-anastomosis, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity, and sufficient blood flow was observed throughout the allograft. Urine output was also observed as soon as blood flow returned, and serum creatinine level decreased to 0.95 mg/dL after surgery. The cause of injury might have been vascular clamping in order to drain the air and check bleeding at the anastomosis. Conclusions: Our case reaffirmed that careful handling is needed in all procedures, including donor nephrectomy, cannulation for transplant perfusion, vascular clamping, and anastomosis, even without any evidence of arteriosclerosis. Kidney transplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Early diagnosis and intervention can lead to the prevention of allograft dysfunction. Therefore, close monitoring of allograft blood flow by Doppler US during surgery should be considered.

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“…12 In addition to living donor transplantation, several cases after deceased donor transplantation were treated with percutaneous transluminal angioplasty. [13][14][15][16] Due to the difficulty of preoperative precise assessment, intensive observation is important particularly after renal transplantation from deceased donor.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplantation from a living donor with renal artery fibromuscular dysplasia: A case report on arterial grafting of the donor renal artery

et al. 2020

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Introduction Renal artery fibromuscular dysplasia is generally considered a contraindication of kidney transplantation, since fibromuscular dysplasia occasionally induces hypertension or renal insufficiency in the recipient and/or donor. To date, limited information remains available with respect to whether kidneys with renal arterial fibromuscular dysplasia can be successfully transplanted. Case presentation A 53‐year‐old potential donor was diagnosed with fibromuscular dysplasia of the right renal artery. Laparoscopic right nephrectomy was performed, and the affected portion was resected and reconstructed using the harvested internal iliac artery. Transplantation was successful and the serum creatinine level was <2 mg/dL for 3 years after surgery. Conclusion If reconstruction of the diseased artery could be safely performed, transplantation using a kidney from a donor with renal artery fibromuscular dysplasia may be considered.

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Fibromuscular dysplasia of the allograft renal artery with early post-operative dissection: successful treatment with intravascular stent insertion

Cited by 11 publications

References 4 publications

Renal Transplantation for Fibromuscular Dysplasia

Renal Transplantation for Fibromuscular Dysplasia

Unexpected presentation and surgical salvage of transplant renal artery dissection caused by vascular clamping: a case report

Kidney transplantation from a living donor with renal artery fibromuscular dysplasia: A case report on arterial grafting of the donor renal artery

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