Management of Transplant Renal Artery Stenosis

Seratnahaei, Arash; Shah, Amber M.; Bodiwala, Kunal; Mukherjee, Debabrata

doi:10.1177/0003319710377076

Cited by 54 publications

(47 citation statements)

References 16 publications

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“…There is significant variability in the reported incidence of TRAS (1-25%) likely secondary to institutional variation of screening protocols, thresholds for intervention and baseline patient demographics (1)(2)(3)(4)(5)(6)(7)(8). The management of TRAS is more widely agreed upon with endovascular intervention (EVI) playing a significant role in preserving graft function and prolonging graft survival (1,(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Biederman

Fischman

Titano

et al. 2015

American Journal of Transplantation

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In this study we analyze the different types of endovascular interventions (EVIs) in de novo transplant renal artery stenosis (TRAS) and its anatomical subtypes to examine any variation in recovery of allograft function, blood pressure control, EVI patency and allograft survival with respect to EVI type (DES: drug-eluting stent, BMS: bare-metal stent, PTA: percutaneous transluminal angioplasty). Forty-five patients underwent a total of 50 primary EVIs (DES: 18, BMS: 26, PTA: 6). Patients were stratified according to medical co-morbidities, graft characteristics, biopsy results, clinical presentation and TRAS anatomic subtypes (anastomotic: 26, postanastomotic: 17, bend-kink: 2). There was significant improvement in allograft function and mean arterial blood pressure (MAP) control across all interventions (pre-EVI-creatinine[CR]: 2.8 AE 1.4, post-EVI-Cr: 2.1 AE 0.7, p < 0.001; pre-EVI-MAP: 117 AE 16, post-EVI-MAP: 112 AE 17, p ¼ 0.03) with no significant difference among EVI types. There was no significant difference in allograft survival with respect to EVI type. Patency was significantly higher in EVIs performed with DES and BMS compared to PTA (p ¼ 0.001). In the postanastomotic TRAS subtype, patency rates were significantly higher in DES compared to BMS (p ¼ 0.012) in vessels of comparable reference diameter ( 5 mm).

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Section: Introductionmentioning

confidence: 99%

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Biederman

Fischman

Titano

et al. 2015

American Journal of Transplantation

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“…5,6 In our centers, the rates are 0.5% to 0.75%. The complication frequently presents with worsening or refractory hypertension, with or without graft dysfunction, in the absence of rejection, ureteric obstruction, or infection.…”

Section: Discussionmentioning

confidence: 68%

Untitled

Soy

Akdur²,

Kırnap³

et al. 2017

Exp Clin Transplant

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Objectives: Despite surgical and medical advances, vascular complications are still among the major concerns after renal transplant, with a reported incidence of 3% to 15%. We evaluated the incidence and management of our transplant team's vascular complications over 40 years. Materials and Methods:From November 1975 to the present, we have performed a total of 2594 renal transplant procedures. Of these, 1997 grafts (76%) were obtained from living donors, and 597 grafts (24%) were obtained from deceased donors. All renal transplant procedures, including those performed in pediatric patients, used the extraperitoneal approach to the contralateral iliac fossa. Revascularization was performed for all grafts. A single end-to-end internal iliac artery anastomosis was performed in 1082 patients (41.8%), an end-to-side external iliac artery anastomosis was performed in 1289 patients (49.7%), and an end-to-side common iliac artery anastomosis was performed in 66 patients (2.5%). In 157 procedures (6%), there were at least 2 renal arteries, and both internal iliac arteries or external iliac arteries were used for anastomosis. Results: We observed 57 vascular complications (2.1%) in 54 renal transplant procedures. The most frequent complication was renal artery stenosis (n = 17; 0.6%). There were 8 instances of renal artery thrombosis (0.4%), 7 of renal artery kinking (0.3%), 5 of renal vein thrombosis (0.2%), 9 of renal vein kinking (0.5%), 3 of external iliac artery dissection (0.01%), 5 renal vein lacerations (0.2%), and 3 renal artery lacerations (0.01%). We performed urgent surgery for 41 vascular complications; 38 were managed successfully.Percutaneous interventional techniques were used successfully for 18 vascular complications. Conclusions: The vascular complication rate in our patients is lower than that reported in the literature. Surgical complications can be minimized with careful transplant technique and close follow-up, as early diagnosis is crucial to early management and successful treatment of complications.

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“…[15][16][17] In our centers, the rates are 0.5% to 0.75%. Renal artery stenosis is diagnosed first using ultrasonography and then angiography.…”

Section: Renal Artery Stenosismentioning

confidence: 64%

Untitled

2016

Exp Clin Transplant

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Since the first successful organ transplant conducted between twins in 1954, kidney transplant has evolved considerably over the past 50 years. Kidney transplant plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of patients. Despite significant advances, postoperative medical and surgical complications still represent important causes of morbidity and mortality. Many problems can be avoided through prophylactic correction of abnormalities detected during the preoperative evaluation; however, it is critical that technical mishaps at all stages of the transplant process (donor nephrectomy, benchwork preparation, and implant) be prevented and that careful postoperative monitoring be carried out, including thorough examination by attending physicians. However, despite these advances, surgical complications still present serious problems in kidney transplant recipients.

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Management of Transplant Renal Artery Stenosis

Cited by 54 publications

References 16 publications

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

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