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Renal artery stenosis in transplanted kidney: management and results in six patients
Insights
Renal artery stenosis in transplanted kidneys can cause severe hypertension and decreased function. Percutaneous transluminal angioplasty is the preferred treatment, with surgery reserved for cases where angioplasty fails.
Area of Science:
- Nephrology
- Transplant Surgery
- Interventional Cardiology
Background:
- Renal artery stenosis (RAS) is a significant complication in kidney transplant recipients.
- It can lead to severe hypertension and graft dysfunction, impacting long-term outcomes.
Purpose of the Study:
- To investigate the incidence and management of RAS in transplanted kidneys.
- To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) versus surgical intervention.
Main Methods:
- Retrospective analysis of 100 kidney transplant recipients followed for over 3 months.
- Identification of RAS cases and review of treatment modalities, including PTA and surgery.
Main Results:
- 6 cases (6%) of RAS were identified.
- PTA was performed in 4 patients; one required repeat PTA, and another underwent surgery.
- Surgery was performed in 2 additional patients, with one failure.
Conclusions:
- Endoarteric lesions during cold perfusion, potentially exacerbated by rejection, may be a key factor in post-transplant RAS.
- PTA is the primary treatment of choice for RAS in transplanted kidneys.
- Surgical intervention should be reserved for cases refractory to PTA.
Abstract:
Severe hypertension and a decrease of renal function, with or without oliguria, suggest renal artery stenosis in the transplanted kidney. 6 renal artery stenoses were observed in 100 transplanted kidneys followed up for more than 3 months. In 4 patients, percutaneous transluminal angioplasty was performed. 1 patient required a new percutaneous transluminal angioplasty 3 months later and a 2nd patient was submitted to surgery after 14 months. Surgery was performed in 2 more cases, with failure in 1. It seems that the endoarteric lesion during cold perfusion could be the main etiopathological factor, when associated with rejection episodes. Percutaneous transluminal angioplasty is the treatment of choice in the management of renal artery stenosis in transplanted kidneys. Surgery must be reserved when it fails.