Ultrasound Screening for Transplant Renal Artery Stenosis Risk Stratification Using Standardized Criteria in...

Area of Science:

• Nephrology
• Radiology
• Vascular Surgery

Background:

• Transplant renal artery stenosis (TRAS) is a significant complication after kidney transplantation.
• Accurate and timely diagnosis of TRAS is crucial for graft survival.
• Current diagnostic pathways may benefit from improved risk stratification tools.

Purpose of the Study:

• To assess the effectiveness of a templated ultrasound reporting system incorporating risk stratification (RS) for transplant renal artery stenosis (TRAS).
• To determine if this system influences the utilization of downstream angiographic studies.
• To evaluate the correlation between risk stratification categories and the angiographic confirmation of TRAS.

Main Methods:

• A retrospective analysis of 530 ultrasound reports with TRAS-RS templated reporting from August 2017 to May 2020.
• Exclusion of studies performed less than 28 days post-transplant or where TRAS was not clinically suspected.
• Stratification into low, intermediate, high, and very high TRAS risk categories based on specific ultrasound criteria (velocity, spectral broadening, acceleration time).

Main Results:

• Of 530 ultrasounds, 74 (14%) underwent angiography, with 41 (8%) positive for TRAS.
• Angiography rates increased progressively with TRAS risk: low (2%), intermediate (28%), high (50%), and very high (74%).
• The TRAS-RS category was significantly associated with both the performance of angiography and the positive rate of TRAS (P < .01).

Conclusions:

• A structured ultrasound screening tool with templated reporting for TRAS enables effective patient selection for angiography.
• This approach optimizes resource utilization by focusing angiographic evaluation on higher-risk patients.
• The TRAS-RS system demonstrates utility in guiding diagnostic workup for post-transplant renal artery stenosis.