3:09 PM Abstract No. 152 Safety and efficacy of angioplasty and/or stenting for transplant renal artery stenosis

Abstract

Transplant renal artery stenosis (TRAS) is a complication that becomes evident within 3 months to 2 years of transplant. The most common location is the anastomotic site, which can lead to allograft failure, refractory hypertension and fluid retention. Percutaneous transluminal angioplasty is the mainstay of treatment. The aim of this study is to assess the safety, technical factors and efficacy of angioplasty and/or stenting in TRAS. This is a single-center retrospective study of all cases of transplant renal artery angioplasty/stenting from 2015-17. Using CPT codes, 81 cases were retrieved, of which 21 cases were selected for the study. Data was retrieved from electronic medical records and PACS. Paired sample t-tests were used for statistical analyses. CO2 contrast was used for all angiography except for the final measurement angiogram prior to and during stent placement. Iodinated contrast volume was restricted to less than 10 mL in all cases. One case was done with CO2 alone. Out of 21 patients, 12 were females and the mean age was 58.9 years (SD 8). Angioplasty alone was done in 9 patients and stenting was done in 12 patients. Mean angioplasty balloon diameter was 4 mm. Mean stent diameter was 4.7 mm. The mean peak systolic velocity (PSV) in the renal artery prior to intervention was 443.7cm/s (SD 104.0) which decreased to 252.0 cm/s (SD 134.4) at a follow-up duration within one month (p<0.001). The mean creatinine prior to intervention was 2.83 mg/dL (SD 1.2) which decreased to 1.81 mg/dL (SD 1.04) at a follow-up duration within 6 weeks (p<0.001). The mean decrease in PSV was 43% (SD 24.5) and the mean fall in creatinine was 35.2% (SD 18.3). The mean improvement in stenosis post intervention was 130% (SD 95). There was no significant correlation between the improvement in stenosis and the improvement in creatinine or PSV (p = 0.38 and p = 0.47 respectively). There were no complications experienced with any of the 21 patient interventions. Angioplasty and stenting is a safe and effective treatment for transplant renal arterial anastomotic stenosis, which significantly improves blood flow and renal function with minimal use of iodinated contrast agents.