Post-Transplant Renal Artery Stenosis: A Possible Immunological Phenomenon

Macía, Manuel; Páez, Álvaro; Tornero, Fernando; Oleo, P. De; Hidalgo, Lucia; Barrientos, Alberto

doi:10.1016/s0022-5347(17)38306-4

Cited by 25 publications

(12 citation statements)

References 7 publications

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“…In smaller retrospective reports, other investigators have found associations of TRAS with both acute rejections and CMV infections [3,12]. Investigators at the University of Minnesota [13] found that recipients who were CMV-negative and then became CMV-positive after transplantation had a significantly higher prevalence of TRAS versus those who remained seronegative.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDS

et al. 2009

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Objective: We analyzed the United States Renal Data System registry to study the risks, predictors, and outcomes of transplant renal artery stenosis (TRAS) in contemporary practice. Methods: The study sampled comprised adults with Medicare primary insurance who received kidney transplants in 2000–2005. We examined associations of recipient, donor and transplant factors with time-to-TRAS by the Kaplan-Meier method and multivariate Cox regression. Survival analysis methods were employed to estimate graft survival after TRAS, and to model TRAS as a time-dependent outcome predictor. Kaplan-Meier analysis was used to estimate time to allograft loss in patients who did or did not have an angioplasty procedure for TRAS. Results: There were 823 cases of TRAS among 41,867 transplant patients, with an incidence rate of 8.3 (95% CI 7.8–8.9) cases per 1,000 patient-years. Mean time to diagnosis of TRAS was 0.83 ± 0.81 years after transplant. Factors associated with TRAS were older recipient and donor age, extended criteria donors, induction immunosuppression, delayed graft function, and ischemic heart disease. There was no association of TRAS with deceased donors, prolonged cold ischemia time, acute rejection or cytomegalovirus status. TRAS was associated with increased risk of graft loss (including death; adjusted hazard ratio 2.84, 95% CI 1.70–4.72). Among the 823 patients with TRAS, 145 (17.6%) underwent angioplasty. Graft survival after TRAS was not significantly different in patients treated with angioplasty compared to those without angioplasty. Conclusions: TRAS is an important complication that predicts adverse patient and graft outcomes. Treatment strategies for TRAS warrant prospective investigation in clinical trials.

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Section: Discussionmentioning

confidence: 99%

Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDS

et al. 2009

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“…In a retrospective review of 110 renal transplants, 8.2% had RAS associated with rejection episodes [26]. In a report of 77 cases of RAS among 917 transplants, Wong et al [22] found a significantly higher prevalence in the group who had suffered AR than in a control group matched for age, year of transplantation, sex, number of previous grafts, and antigens [22].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of transplant renal artery stenosis in children

Repetto¹,

Rodríguez-Rilo²,

Mendaro³

et al. 2004

Pediatr Nephrol

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Percutaneous treatment of renal artery stenosis (RAS) is an accepted procedure and numerous reports have been published. However, experience with its use in RAS in the transplanted kidney in children is scarce. Since 1994 we have diagnosed RAS in seven children with the use of Doppler ultrasonography (US), confirming it with percutaneous angiography (PAG). In six of the seven patients percutaneous transluminal angioplasty (PTA) was performed. In one patient a metallic stent was placed due to the extension of the arterial lesion, and a second stent was placed in another child when a re-stenosis was diagnosed 1 month after the PTA. All patients presented with hypertension (de novo or 30% increase over previous values). After ruling out acute rejection, calcineurin inhibitor toxicity, and urinary obstruction, US was performed and, when an increase in arterial flux velocity was registered, PAG was also performed. Six children showed an increase in serum creatinine (Cr) and proteinuria. Blood pressure decreased after the procedure and Cr returned to previous levels in all children. One of the grafts was lost due to chronic transplant rejection 7 years later. The other children have a functioning kidney. Although this is a small group of patients, the consistently good results and the lack of reported experience prompted us to communicate our preliminary observation.

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“…All patients trans planted at our centre are examined by regular Doppler ultrasonography which is a reliable and very sensitive technique for the detection of vascular stenosis. Renal artery stenosis has also been reported in an immunoadsorbed patient at another centre [41], It has previously been suggested that renal artery stenosis after transplanta tion could be mediated by immunological damage to the vascular endothelium [18,19]. However, we have no direct evidence linking antibody levels with vascular ste noses in our patients, and indeed 1 of our patients with renal artery stenosis had no clinical or renal biopsy evi dence of rejection throughout.…”

Section: Discussionmentioning

confidence: 44%

5-Year Follow-Up of Patients Successfully Transplanted after Immunoadsorption to Remove Anti-HLA Antibodies

Higgins

Bevan

Vaughan

et al. 1996

Nephron

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The function of renal allografts in patients who had received pretransplant immunoadsorption in order to remove cytotoxic anti-HLA antibodies was studied. We reviewed 6 patients who received a graft which functioned beyond 3 months; the mean follow-up period was 76 (range 62-89) months. Two grafts have been lost from chronic rejection, at 12 and 62 months, respectively. The mean plasma creatinine levels at 1 and 5 years were 169 (range 143-211) μmol/l and 155 (range 92-235) μmol/l, respectively (1.91, range 1.62-2.39, mg/dl and 1.75, range 1.04-2.66, mg/dl, respectively). The major source of morbidity during long-term follow-up has been the occurrence of renal artery stenosis in 5 patients and renal vein stenosis in 1. In conclusion, the 5-year graft survival and function was good in patients who received immunoadsorption and whose grafts survived beyond the first 3 months after transplantation.

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Post-Transplant Renal Artery Stenosis: A Possible Immunological Phenomenon

Cited by 25 publications

References 7 publications

Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDS

Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDS

Percutaneous treatment of transplant renal artery stenosis in children

5-Year Follow-Up of Patients Successfully Transplanted after Immunoadsorption to Remove Anti-HLA Antibodies

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