Management of transplant renal artery stenosis and its impact on long-term allograft survival: a single-centre experience
- 2 July 2010
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 26 (1), 336-343
- https://doi.org/10.1093/ndt/gfq393
Abstract
Transplant renal artery stenosis (TRAS) is a recognized complication resulting in post-transplant hypertension associated with allograft dysfunction. It is a commonly missed but potentially treatable complication that may present from months to years after transplant surgery. In this retrospective study, we compared management strategies and outcomes of TRAS from 1990 to 2005. Case notes of transplant recipients with TRAS demonstrated by angiography were reviewed. Angiography and was carried out when there was a clinical or Doppler ultrasound suspicion of TRAS. The clinical diagnosis of TRAS was based on uncontrolled refractory/new-onset hypertension and/or unexplained graft dysfunction in the absence of another diagnosis, such as rejection, obstruction or infection. The two-tailed Student t-test was used to analyse the differences between mean arterial pressure, serum creatinine, and estimated glomerular filtration rate before and after the intervention. Sixty-seven patients with angiogram-confirmed TRAS were included. Forty-four, 9 and 14 patients were managed with primary percutaneous transluminal renal angioplasty (PTRA), surgical intervention and conservative treatment, respectively. Uncontrolled hypertension was the most common presentation noted in 74.62%. Post-anastamotic single stenosis was the commonest occurrence (n = 53). Angioplasty had the highest 1- and 5-year graft survival rate of 91% and 86%, respectively. The worst prognosis was noted in patients treated with secondary PTRA after failed surgery or secondary surgery after failed primary PTRA. TRAS is a recognized complication resulting in loss of renal allografts. Early Doppler ultrasound is a good primary diagnostic tool. Early intervention is associated with a good long-term graft function.This publication has 22 references indexed in Scilit:
- UK Renal Registry 11th Annual Report (December 2008): Chapter 5 Demographics and biochemistry profile of kidney transplant recipients in the UK in 2007: national and centre-specific analysesNephron Clinical Practice, 2009
- Detection and treatment of transplant renal artery stenosisIndian Journal of Urology, 2009
- Adverse impact of pretransplant polyoma virus infection on renal allograft functionNephrology, 2008
- Recurrent or De Novo IgA Nephropathy with Crescent Formation after Renal TransplantationRenal Failure, 2008
- Early and late urological complications corrected surgically following renal transplantationTransplant International, 2007
- Vascular Complications After Live Donor Renal Transplantation: Study of Risk Factors and Effects on Graft and Patient SurvivalJournal of Urology, 2003
- Cost-effectiveness analysis of dialysis and kidney transplants in Japan.The Keio Journal of Medicine, 2001
- Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996The New England Journal of Medicine, 2000
- Transplant Renal Artery Stenosis Presenting with Recurrent Acute Pulmonary EdemaNephron, 1996
- PERCUTANEOUS TRANSLUMINAL ANGIOPLASTYTransplantation, 1987