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Transplant renal artery stenosis
Simona Bruno1, Giuseppe Remuzzi, Piero Ruggenenti
1Department of Medicine and Transplantation, Azienda Ospedaliera, Ospedali Riuniti di Bergamo-Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
Journal of the American Society of Nephrology : JASN
|December 25, 2003
Summary
Transplant renal artery stenosis (TRAS) is a common complication after kidney transplants, leading to hypertension and graft dysfunction. Percutaneous transluminal angioplasty (PTA) is the preferred treatment, with high success rates in restoring kidney perfusion.
Area of Science:
- Nephrology
- Transplantation Surgery
- Vascular Surgery
Background:
- Transplant renal artery stenosis (TRAS) is a significant complication following kidney transplantation.
- It can lead to posttransplant hypertension, allograft dysfunction, and graft loss.
- Prevalence varies widely (1-23%) due to diagnostic criteria and surgical techniques.
Purpose of the Study:
- To review the diagnosis, treatment, and outcomes of transplant renal artery stenosis (TRAS).
- To highlight the role of imaging and interventional procedures in managing TRAS.
- To discuss strategies for preventing restenosis after angioplasty.
Main Methods:
- Review of existing literature on transplant renal artery stenosis.
- Discussion of diagnostic modalities including Doppler ultrasonography, MR angiography, and invasive angiography.
- Analysis of treatment outcomes for percutaneous transluminal angioplasty (PTA) and surgical interventions.
Main Results:
- Non-invasive imaging like Doppler ultrasonography can detect potential TRAS.
- Definitive diagnosis requires invasive angiography.
- Percutaneous transluminal angioplasty (PTA) successfully restores kidney perfusion in 60-90% of cases.
- Expandable endoprostheses help prevent restenosis.
Conclusions:
- TRAS is a treatable cause of posttransplant complications.
- PTA is the primary treatment, with surgery reserved for refractory cases.
- Doppler ultrasonography is crucial for pre- and post-revascularization assessment.