Spontaneous recanalization of occluded transplant renal artery: a rare case report

Transplant renal artery stenosis (TRAS) is a serious vascular complication that occurs after renal transplantation and can result in hypertension, renal functional impairment, and graft loss. Endovascular treatment has become the first-line treatment for TRAS because of its low invasiveness and high success rate.

A 23-year-old female with end-stage renal disease of unknown cause received a living-donor kidney transplantation 10 months ago. Seven months after the transplantation, her blood pressure gradually deteriorated. Magnetic resonance angiography revealed bending and stenosis of the transplant renal artery, and the patient received endovascular treatment. A digital subtraction angiography revealed significant stenosis of 95% in the proximal transplant renal artery. The guidewire could not pass through the stenotic segment of the transplant renal artery even with repeated attempts by the surgeons; as a result, the transplant renal artery became occluded, and vasodilators were ineffective. After the operation, renal function gradually worsened, so she began to receive regular dialysis. Twenty-five days later, the patient's urine volume was significantly higher than that before, and ultrasound showed that the proximal transplant renal artery was not completely occluded. A re-intervention was performed, and the stent was placed successfully in the stenotic segment. After the operation, renal function gradually recovered, and dialysis was no longer needed.

Patients with iatrogenic transplant renal artery occlusion may have the possibility of spontaneous recanalization, which can help prevent the need for re-transplantation.