Endovascular Treatment of Transplant Renal Artery Stenosis: Evaluation of Postoperative Outcomes and Risk Factors for Recurrence

Abstract

Angioplasty with or without stenting has become a well-established procedure to treat transplant renal artery stenosis (TRAS). We evaluated our experience on postoperative outcomes following the intervention and identified potential predictive factors of TRAS recurrence. Consecutive patients who underwent endovascular treatment of TRAS were retrospectively reviewed. The study end points were the technical success, 30-day postoperative complications, and the estimated glomerular filtration rate (eGFR). Thirty-two patients underwent endovascular treatment for TRAS. The technical success rate was 96.6%. Complications were observed for 7 (21.9%) patients: 4 had a dissection, 2 a pseudoaneurysm, and 1 (3.1%) patient developed an acute pulmonary edema. The mean eGFR significantly increased at 7 days, 3 months, and 6 months postintervention (43.1, 44.9, and 44.3 vs 33.9 mL/min/1.73 m² preoperatively, P < .05). The TRAS recurrence was observed in 7 (21.9%) patients. These patients had significantly higher preoperative peak systolic velocity and systolic rise time (5 vs 4 m/s, P = .0383 and 103 vs 80 milliseconds, P = .0148, respectively). Endovascular treatment of TRAS is associated with high technical success and significant improvement in renal function. Further studies are required to confirm predictive factors of TRAS recurrence following endovascular treatment.

Keywords

transplant renal artery stenosis endovascular repair postoperative outcome

Get full access to this article

View all access options for this article.

References

Bongiovanni

Couillerot-Peyrondet

Sambuc

. Cost-effectiveness analysis of various strategies of end-stage renal disease patients’ care [in French]. Nephrol Ther. 2016;12(2):104–15.

Ngo

Markar

De Lijster

Duncan

Taube

Hamady

. A systematic review of outcomes following percutaneous transluminal angioplasty and stenting in the treatment of transplant renal artery stenosis. Cardiovasc Intervent Radiol. 2015;38(6):1573–88.

Bruno

Remuzzi

Ruggenenti

. Transplant renal artery stenosis. J Am Soc Nephrol. 2004;15(1):134–41.

Audard

Matignon

Hemery

. Risk factors and long-term outcome of transplant renal artery stenosis in adult recipients after treatment by percutaneous transluminal angioplasty. Am J Transplant. 2006;6(1):95–9.

Hurst

Abbott

Neff

. Incidence, predictors and outcomes of transplant renal artery stenosis after kidney transplantation: analysis of USRDS. Am J Nephrol. 2009;30(5):459–67.

Sankari

Geisinger

Zelch

Brouhard

Cunningham

Novick

. Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control. J Urol. 1996;155(6):1860–4.

Rengel

Gomes-Da-Silva

Inchaustegui

. Renal artery stenosis after kidney transplantation: diagnostic and therapeutic approach. Kidney Int Suppl. 1998;68:S99–106.

Braga

Catto

Dalio

. Endovascular approach to transplant renal artery stenosis. Ann Transplant. 2015;20:698–706.

Chew

Tan

Kumar

. Percutaneous transluminal angioplasty of transplant renal artery stenosis. Ann Acad Med Singapore. 2014;43(1):39–43.

10.

Fluck

Preston

McKane

. Intra-arterial stenting for recurrent transplant renal artery stenosis. Transplant Proc. 2001;33(1-2):1245–6.

11.

Filiopoulos

Boletis

. Renal transplantation with expanded criteria donors: which is the optimal immunosuppression? World J Transplant. 2016;6(1):103–14.

12.

Patel

Jindal

Wilkin

. Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology. 2001;219(3):663–7.

13.

Beecroft

Rajan

Clark

Robinette

Stavropoulos

. Transplant renal artery stenosis: outcome after percutaneous intervention. J Vasc Interv Radiol. 2004;15(12):1407–13.

14.

Dindo

Demartines

Clavien

. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

15.

Centre de Biologie Médicale, http://www.cbm25.fr/formule-creatinine. Accessed March 03, 2018.

16.

Del Pozo

Marti

Guirado

. Angioplasty and stent treatment of transplant renal artery stenosis. Nefrologia. 2012;32(4):455–8.

17.

Abate

Kaur

Suh

Darras

Mani

Nord

. The use of drug-eluting stents in the management of transplant renal artery stenosis. Am J Transplant. 2011;11(10):2235–41.

18.

Bruno

Ferrari

Remuzzi

Ruggenenti

. Doppler ultrasonography in posttransplant renal artery stenosis: a reliable tool for assessing effectiveness of revascularization? Transplantation. 2003;76(1):147–53.

19.

Touma

Costanzo

Boura

Alomran

Combes

. Endovascular management of transplant renal artery stenosis. J Vasc Surg. 2014;59(4):1058–65.

20.

Lian

Chang

. Long-term outcomes of patients treated with primary stenting for transplant renal artery stenosis: a 10-year case cohort study. World J Surg. 2012;36(1):222–8.

21.

Tang

Tso

Chan

Lai

. Clinical outcome following percutaneous transluminal angioplasty for transplant renal artery stenoses. Transplant Proc. 2000;32(7):1889–91.

22.

Ghirardo

De Franceschi

Vidal

. Transplant renal artery stenosis in children: risk factors and outcome after endovascular treatment. Pediatr Nephrol. 2014;29(3):461–7.

23.

Ghazanfar

Tavakoli

Augustine

Pararajasingam

Riad

Chalmers

. Management of transplant renal artery stenosis and its impact on long-term allograft survival: a single-centre experience. Nephrol Dial Transplant. 2011;26(1):336–3.

24.

Chen

Kayler

Zand

Muttana

Chernyak

DeBoccardo

. Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy. Clin Kidney J. 2015;8(1):71–8.

25.

Browne

Tuite

. Imaging of the renal transplant: comparison of MRI with duplex sonography. Abdom Imaging. 2006;31(4):461–82.

26.

Granata

Clementi

Londrino

. Renal transplant vascular complications: the role of Doppler ultrasound. J Ultrasound. 2015;18(2):101–7.

27.

Radermacher

Chavan

Bleck

. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med. 2001;344(6):410–7.

28.

Crutchley

Pearce

Craven

Stafford

Edwards

Hansen

. Clinical utility of the resistive index in atherosclerotic renovascular disease. J Vasc Surg. 2009;49(1):148–55.e1-3; discussion 55.

29.

Chen

De Mattos

Bang

. Angioplasty vs stent in the treatment of transplant renal artery stenosis. Clin Transplant. 2018;32(4):e13217.

30.

Puoti

Ricci

Nanni-Costa

Ricciardi

Malorni

Ortona

. Organ transplantation and gender differences: a paradigmatic example of intertwining between biological and sociocultural determinants. Biol Sex Differ. 2016;7:35.

31.

Chen

Tsai

Lee

. Gender differences in renal transplant graft survival. J Formos Med Assoc. 2013;112(12):783–8.

32.

Muller

Szabo

Viklicky

. Sex hormones and gender-related differences: their influence on chronic renal allograft rejection. Kidney Int. 1999;55(5):2011–20.