Renal allograft artery stenosis: results of medical treatment and intervention. A retrospective analysis

Abstract

In a retrospective analysis of 1165 renal transplantations in our center, 65 cases of renal allograft artery stenosis were diagnosed angiographically (prevalence 5.5%). Hypertension was present in all cases; a bruit over the allograft and an increase in serum creatinine level were additional reasons for angiography. Shortly after diagnosis of the stenosis, two patients died and two others lost their grafts due to thrombosis. In 24 patients the decision was made not to correct the stenosis. One of these grafts was lost because the stenosis could not be corrected. Medical management of hypertension in these patients resulted in a decrease in diastolic blood pressure from 109 +/- 22 to 96 +/- 12 mm Hg (P < 0.01) 3 months after diagnosis with the use of almost twice as many antihypertensive drugs as at the time of diagnosis (P < 0.01). The stenosis was corrected if the angiography showed it to be so severe that it jeopardized renal allograft function or caused uncontrollable hypertension. Only three of nine percutaneous transluminal angioplasty (PTA) procedures resulted in a definitive correction of the stenosis. Surgical intervention was performed in 30 patients, including two patients whose PTAs had proved unsuccessful. Surgery led to graft loss due to thrombosis in 6 of 30 operations (20%), whereas restenosis occurred twice (7%). In three other cases (10%), the correction was not successful due to local anatomical variations or concomitant rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

The Use of Drug-Eluting Stents in the Management of Transplant Renal Artery Stenosis

“…The median time in months from transplantation to diagnosis of TRAS was 4.1 (range 1. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Upon presentation, all 12 patients were hypertensive and had allograft dysfunction, more than half (7/12) had dependent edema, and a quarter had a bruit on auscultation.…”

“…The technical success rate for PTA varies widely between 70% and 90%, with complications of flow limiting dissections, distal embolization, thrombosis, rupture and residual disease prompting bail-out stenting. PTA also has a restenotic rate between 10% and 60% at 6-8 months (6). Stents offer improved procedural success with sealing of dissections, reduced risk of abrupt vessel closure, reduced immediate residual stenosis and a reduced restenotic rate in the region of 10-30% (3,7).…”

“…Percutaneous transluminal transplant angioplasty (PTA) is successful in restoring kidney perfusion with an initial procedural success rate approaching 80-100% (3,4) and a clinical success rate (defined as improvement in hypertension and improvement or stabilization of graft function) of 75% (4,5). However, recurrent TRAS following PTA alone occurs frequently with a reported incidence rate of 10-36% over 6-8 months (6). The risk of recurrence can be substantially reduced when PTA is combined with the placement of a stent (7).…”

Hypertension in the Transplanted Patient

“…Stenosis of the transplant renal artery is not as common as it used to be, but it is still seen in approximately 2–6% of all patients [32, 33]. Its frequency seems to increase with the intensity with which it is sought.…”

Calcium Channel Blockers as the Treatment of Choice for Hypertension in Renal Transplant Recipients: Fact or Fiction

“…Stenosis of the transplanted renal artery is seen in about 6% of patients. 8 Several clinical signs exist that, although not diagnostic, may be suggestive of transplant renal artery stenosis. These include accelerated hypertension, a decrease in glomerular filtration rate (GFR) after the administration of an ACE inhibitor, or a bruit over the graft.…”