Outcomes of endovascular treatment of renal arterial stenosis in transplanted kidneys

Marchini, Giovanni Scala; Bull, Alexandre; Piovesan, Affonso; Yamaçake, Kleiton; Antonopoulos, Ioannis; Falci, Renato; Kanashiro, Hideki; Ebaid, Gustavo; Carnevale, Francisco César; Messi, Gustavo; Nahas, William Carlos

doi:10.1590/s1677-5538.ibju.2018.0737

Cited by 5 publications

(3 citation statements)

References 15 publications

(13 reference statements)

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“…Only 35 studies provided enough data for meta-analysis. An overall summary of the included studies, size, and evidence grading can be found in Supplemental Table S1 2,4,7,12,27-77 . We propose a diagnostic and therapeutic algorithm that reflects the findings, which is displayed in Figure 2 on the basis of the frequency of reporting cutoff parameters.…”

Section: Resultsmentioning

confidence: 99%

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

et al. 2021

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Objective Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. Methods A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Results Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17–1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40–0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29–14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29–1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41–251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14–0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75–1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. Conclusion The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.

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Section: Resultsmentioning

confidence: 99%

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

et al. 2021

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“…The treatment measures for TRAS include optical medical administration alone, surgical revascularization and percutaneous transluminal angioplasty with or without stenting[ 14 ]. As a less invasive approach than surgery, percutaneous transluminal angioplasty with stenting has become the first-line option without the support of very strong evidence[ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and spontaneous healing of asymptomatic renal allograft extra-renal pseudo-aneurysm: A case report

Xu¹,

He²,

Yi³

et al. 2021

WJCC

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BACKGROUND Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation. However, extra-renal pseudo-aneurysms (EPSAs) are rare after transplantation; they can be life-threatening and usually need open surgical repair. We discuss the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis, which was diagnosed in a timely manner and managed by conservative treatments. CASE SUMMARY We present a 37-year-old male patient diagnosed with a renal allograft EPSA caused by renal artery anastomotic stenosis due to multiple atherosclerotic plaques with ultrasonographic examination 6 mo post transplantation. The stenosis rate of 90% and the EPSA were verified by computed tomography angiography. The diagnosis was further confirmed with digital subtraction angiography. Percutaneous transluminal angiography was conducted, and a metallic stent was successfully implanted at the stenosed site of the main renal artery trunk. No further intervention for the EPSA was undertaken due to the difficulty of stenting and the risk of bleeding; regular ultrasonographic follow-ups were recommended. The stenosis was significantly relieved immediately after stent implantation and the EPSA was healed spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting. CONCLUSION Ultrasonography combined with a high-frequency linear probe can detect vascular complications post renal transplantation at an early stage and improve prognosis.

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“…Drug treatment could control renovascular hypertension, but it could not prevent the progression of RAS. PTRA could significantly improve renal blood flow and reduce blood pressure, also ensure the functionality of the graft and normalization of renal function, 9 while surgery is only performed when contraindications for PTRA exists.…”

Section: Discussionmentioning

confidence: 99%

Zero‐contrast PTRA and stenting for child with TRAS: A case report

Xie

Qiu

et al. 2021

Pediatric Transplantation

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Background Kidney transplantation is often complicated by TRAS, and PTRA can effectively treat it. However, PTRA is not appropriate for patients with CKD because iodinated contrast agent may induce nephropathy. Methods This article reports about a 14‐year‐old boy with a history of kidney transplantation complicated by RAS. He initially underwent percutaneous balloon dilation to relieve the stenosis. One and half a year after dilation, he received zero‐contrast PTRA and stenting under the guidance of external and IVUS with reference to previous PAG image. Results After successful stent implantation, the cross‐sectional area of the renal artery lumen was significantly increased.The blood pressure and level of creatinine also decreased and kept stable during follow‐up. Conclusion This report suggests the feasibility of external ultrasound and IVUS guided, zero‐contrast PTRA in patients with poor renal function or iodinated contrast allergy.

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Outcomes of endovascular treatment of renal arterial stenosis in transplanted kidneys

Cited by 5 publications

References 15 publications

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

Diagnosis and spontaneous healing of asymptomatic renal allograft extra-renal pseudo-aneurysm: A case report

Zero‐contrast PTRA and stenting for child with TRAS: A case report

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