Endovascular management of transplant renal artery stenosis

Most clinicians regard angioplasty with or without stent placement to be the treatment of choice for transplant renal artery stenosis (TRAS). However, published results regarding its effectiveness are heterogeneous. The aim of this study was to assess the safety and efficiency of TRAS endovascular therapy.

All cases of TRAS admitted for treatment in our unit from January 2009 to December 2012 were reviewed retrospectively. The primary end point was the stenosis-free primary transplant renal artery patency. Secondary end points were freedom from reintervention, graft survival, postoperative serum creatinine level, blood pressure evolution, and the number of antihypertensive drugs pre- and postprocedure.

A total of 17 patients (10 men, 7 women) presenting with TRAS were referred to our institution. During the early post-transplantation process (<15 days), 35.2% of patients presented. The median time to presentation was 40 days. The predominant presentation was graft function alteration (82.3%). Percutaneous balloon angioplasty was performed in five patients (29.4%), while stenting was performed in the remaining 12 patients (70.6%). The stenosis-free primary patency rate and freedom from reintervention rate were 76.5% and 88.2%, respectively. The median follow-up was 19.6 months with 88.2% graft survival. There were no mortalities throughout the follow-up period. Serum creatinine levels decreased significantly from 186 μmol/L (range, 148-310 μmol/L) preoperatively to 160 μmol/L (range, 127-236 μmol/L at discharge (P = .0036). The glomerular filtration rates increased from 32.1 mL/min (range, 21.4-45.8 mL/min) to 41.7 mL/min (range, 27.5-52.4 mL/min; P = .004). Systolic and diastolic blood pressure varied from 140 mm Hg (range, 137-157 mm Hg) and 75 mm Hg (range, 70-80 mm Hg), to 135 mm Hg (range, 130-147 mm Hg and 80 mm Hg (range, 73-80 mm Hg), respectively (P = .11 and P = .36). The preoperative number of antihypertensive medications was 2 (range, 1-3) and remained unchanged (P = .33).

The endovascular management of TRAS is safe and presents a high rate of technical success with low morbidity. Its impact on serum creatinine levels is significant in our experience. However, the blood pressure items do not seem to improve postoperatively.