Silent but Severe: Transplant Renal Artery Stenosis Causing Acute Graft Dysfunction in a Child With Cystinosis

Transplant renal artery stenosis (TRAS) is a potentially reversible vascular complication after kidney transplantation and an important cause of graft dysfunction in children. It usually presents with hypertension and/or impaired graft function but may occasionally remain clinically silent.

We report an 11-year-old girl with cystinosis who underwent living-donor kidney transplantation outside our national, regulated transplant program and was referred to our center for follow-up. Early post-transplant Doppler ultrasonography was normal. At 10 weeks post-transplant, she developed an asymptomatic but severe rise in serum creatinine without hypertension. Imaging revealed a short, focal stenosis at the arterial anastomosis. Percutaneous transluminal angioplasty was successfully performed, followed by short-term anticoagulation and antiplatelet therapy, with rapid and sustained recovery of graft function.

This case highlights that TRAS may present without hypertension and underscores the importance of careful surveillance, particularly in children transplanted outside regulated transplant programs.