Renal Transplant Arterial Stenosis Treated With Bare-Metal Versus Drug-Eluting Stents: Comparison of Treatment Outcomes

Hanna, Robert F.; Hao, Frank; Kraus, Carl; Mitsopoulos, Georgios; Goldstein, Gideon; Weintraub, Joshua; Sperling, David; Susman, Jonathan; Schlossberg, Peter; Sheynzon, V.

doi:10.1016/j.transproceed.2015.09.062

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…For this purpose, attention has turned to the use of DES due to the incidence of restenosis associated with BMS placement. Recent studies have reported that primary stenting with either DES or BMS was a safe and effective therapy for TRAS, but DES conferred no significant advantage in terms of rate of restenosis compared to BMS [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Apart from bend-kink, suture, and donor procurement, intimal hyperplasia, fibrosis or scarring, and immunological disorder are the main risk factors of TRAS [ 4 ]. Percutaneous transluminal angioplasty (PTA), alone or using a stent, was accepted as initial therapy for TRAS [ 4 , 5 ]. However, the incidence of restenosis for PTA alone ranges from 15% to 28% [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Outcomes Using a Drug-Coated Balloon for Transplant Renal Artery Stenosis

Shang

Tian

et al. 2018

Ann Transplant

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BackgroundThis study aimed to evaluate the early and mid-term outcomes of drug-coated balloon (DCB) use in patients who underwent intervention for transplant renal artery stenosis (TRAS).Material/MethodsWe retrospectively reviewed the records of TRAS patients who received endovascular therapy with DCB in our institution from March 2016 to January 2017. Statistical analysis of pre-/postoperative levels of serum creatinine (Scr), systolic blood pressure (SBP), and renal artery peak systolic velocities (PSV) were performed.ResultsFourteen patients presenting with TRAS, which were mostly located at the anastomosis (n=9) and transplanted artery proximal portion (n=2), were treated with DCB. Three TRAS patients with in-stent restenosis (ISR) were also included in the series. The procedure technique success rate was 100%. The mean follow-up time was 8.6 months. The Scr level decreased from 481.8 μmol/L (208.5–746.2μmol/L) pre-operation to 154μmol/L (89.1–301.2 μmol/L, p<0.01) at 1 month post-intervention. The SBP varied from 161.4 mmHg (152–173 mmHg) to 144.8 mmHg (136–154 mmHg, p<0.01). Renal artery PSV decreased from 364.1 cm/s (217.6–511.9 cm/s) to 134.9 cm/s (79.8–184.2 cm/s, p<0.01). Eleven patients finished mid-term (>6 months) follow-up. The statistical results were not significant compared to those at 1 month, although they all slightly decreased. No re-intervention was performed.ConclusionsThe endovascular approach to TRAS with DCB was a safe and effective treatment for restore and maintain the artery flow and renal function in short-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short-Term Outcomes Using a Drug-Coated Balloon for Transplant Renal Artery Stenosis

Shang

Tian

et al. 2018

Ann Transplant

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“…Compared with bare-metal stents (BMS), drug-eluting stents (DES), which decrease cellular proliferation and intimal hyperplasia, have shown superior patency in the treatment of coronary artery disease [10]. DES have also been used to treat transplant renal artery stenosis (TRAS) [11,12].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Hepatic Artery Stenosis in Liver Transplant Patients Using Drug-Eluting versus Bare-Metal Stents

Naidu

Alzubaidi

Knuttinen

et al. 2021

JCM

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Hepatic artery stenosis after liver transplant is often treated with endovascular stent placement. Our institution has adopted use of drug-eluting stents, particularly in small-caliber arteries. We aimed to compare patency rates of drug-eluting stents vs. traditional bare-metal stents. This was a single-institution, retrospective study of liver transplant hepatic artery stenosis treated with stents. Primary patency was defined as time from stent placement to resistive index on Doppler ultrasonography (<0.5), hepatic artery thrombosis, or any intervention including surgery. Fifty-two patients were treated with stents (31 men; mean age, 57 years): 15, drug-eluting stents; 37, bare-metal stents. Mean arterial diameters were 4.1 mm and 5.1 mm, respectively. Technical success was 100% (52/52). At 6 months, 1, 2, and 3 years, primary patency for drug-eluting stents was 80%, 71%, 71%, and 71%; bare-metal stents: 76%, 65%, 53%, and 46% (p = 0.41). Primary patency for small-caliber arteries (3.5–4.5 mm) with drug-eluting stents was 93%, 75%, 75%, and 75%; bare-metal stents: 60%, 60%, 50%, and 38% (p = 0.19). Overall survival was 100%, 100%, 94%, and 91%. Graft survival was 100%, 98%, 96%, and 90%. Stenting for hepatic artery stenosis was safe and effective. While not statistically significant, patency improved with drug-eluting stents compared with bare-metal stents, especially in arteries < 4.5 mm in diameter. Drug-eluting stents can be considered for liver transplant hepatic artery stenosis, particularly in small-caliber arteries.

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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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Renal Transplant Arterial Stenosis Treated With Bare-Metal Versus Drug-Eluting Stents: Comparison of Treatment Outcomes

Cited by 10 publications

References 21 publications

Short-Term Outcomes Using a Drug-Coated Balloon for Transplant Renal Artery Stenosis

Short-Term Outcomes Using a Drug-Coated Balloon for Transplant Renal Artery Stenosis

Treatment of Hepatic Artery Stenosis in Liver Transplant Patients Using Drug-Eluting versus Bare-Metal Stents

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

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