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Long-Term Graft and Patient Survival Following Endovascular Intervention for Renal Artery Stenosis in Transplanted
Mennatalla Hegazi1, Nii-Kabu Kabutey1, Robert R Redfield2
1Division of Vascular and Endovascular Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA.
Background:
Transplant renal artery stenosis (TRAS) is a recognized etiology of allograft dysfunction and potential graft loss. Endovascular therapy via carbon dioxide angiography (CO2A) and angioplasty/stenting represents an opportunity to mitigate allograft failure in transplant patients with progressive TRAS. We present our institutional experience with CO2A and endovascular interventions in treating TRAS.
Methods:
A retrospective review was performed of all renal transplant patients who underwent CO2A for suspected TRAS between March 2017 and July 2024. The diagnosis of TRAS was based on duplex ultrasound (DUS) and unexplained graft dysfunction in the absence of ureteral obstruction, infection, or acute rejection. Pre and postintervention creatinine (Cr), DUS velocities, and freedom from dialysis at 6 months, 1 year, and 5 years were examined. Statistical analysis was performed using Wilcoxon signed-rank test.
Results:
19 patients were identified who underwent 23 endovascular procedures for transplant renal artery stenosis, comprising 1.7% of all transplant patients in that time frame. 3 patients underwent diagnostic CO2A without intervention and were excluded from analysis. The remaining 16 patients (56% male) had a mean age of 52 years. Time from transplant to TRAS intervention averaged 196 days (range 55-726). Anastomotic peak systolic velocity (PSV)pre and postintervention averaged 426 cm/s (SD = 235) and 263 cm/s (SD = 124), (P = 0.015), respectively. TRAS was resolved or improved based on DUS in 12 of 16 patients; the median balloon size used for angioplasty was 3.5 mm (range 2.5-5 mm). Preto postintervention Cr decreased from mean 3.2 (SD = 1.4) to 1.6 (SD = 0.5) (P < 0.001). 14 (75%) patients were free from dialysis at 6 months from TRAS intervention. At the 5-year follow-up period, 6 transplanted kidneys were still functioning, and 100% of those functioning at 1 year were still functioning at 5 years, with no TRAS reintervention after the first year. In our cohort, patient survival was 100%.
Conclusion:
Juxta-anastomotic TRAS associated with rapidly progressive allograft dysfunction can be successfully salvaged with a high rate of success with CO2A and angioplasty/stenting. This can lead to high rates of long-term allograft and patient survival.
Insights
Transplant renal artery stenosis (TRAS) can be effectively treated with carbon dioxide angiography (CO2A) and angioplasty/stenting, leading to improved graft function and high patient survival rates. This endovascular approach offers a successful salvage option for failing kidney transplants.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Transplant renal artery stenosis (TRAS) is a significant cause of kidney allograft dysfunction and loss.
- Endovascular therapy, including carbon dioxide angiography (CO2A) and angioplasty/stenting, offers a potential solution for managing progressive TRAS.
Purpose of the Study:
- To evaluate the institutional experience with CO2A and endovascular interventions in treating transplant renal artery stenosis.
- To assess the efficacy and long-term outcomes of this approach in salvaging kidney allografts.
Main Methods:
- Retrospective review of renal transplant patients who underwent CO2A for suspected TRAS (March 2017-July 2024).
- Diagnosis based on duplex ultrasound (DUS) and graft dysfunction, excluding obstruction, infection, or rejection.
- Analysis of pre- and post-intervention creatinine, DUS velocities, and freedom from dialysis at 6 months, 1 year, and 5 years.
Main Results:
- 16 patients underwent 23 endovascular procedures for TRAS, with a mean age of 52 years.
- Post-intervention, anastomotic peak systolic velocity (PSV) significantly decreased (p=0.015), and creatinine levels improved (p<0.001).
- 75% of patients were dialysis-free at 6 months, with 100% patient survival and significant long-term graft survival observed.
Conclusions:
- CO2A combined with angioplasty/stenting is a successful endovascular strategy for salvaging kidney allografts with juxta-anastomotic TRAS.
- This intervention leads to significant improvements in graft function and high rates of long-term allograft and patient survival.
