Arterial stenosis complicating renal allotransplantation in man: a study of 38 cases

Of 306 renal transplantations, stenosis of the artery supplying the grafted kidney was found in 38 patients three months to two years after they had undergone renal transplantation. The diagnosis was made by arteriography done because of refractory hypertension with or without impaired renal function in 36 patients and as a routine investigation in two normotensive patients. The stenosis was corrected surgically in 14 patients, with resultant lasting relief of hypertension in ten patients and improvement of renal function in five out of six patients with impaired renal function. Different types of stenosis were recognized: stenosis of the recipient artery, stenosis of the suture line, stenosis of the donor renal artery (segmental or diffuse) and multiple forms. The most frequent site of stenosis was the donor artery. There seems to be no single cause of stenosis: atheroma of the recipient vessels, faulty suture technique, hemodynamic disturbances, trauma to donor or recipient arteries account for some cases, whereas in other cases the evidence points to an immune mechanism. This complication of renal transplantation may be more frequent than is thought at present; therefore, routine renal arteriography should be performed at repeated intervals in all transplanted patients.