38 Long-term Follow-up of Renal Transplant Artery Stenosis: Case Controlled Study

Abstract

Background Renal transplant artery stenosis is relatively frequent. It can cause hypertension, deterioration of renal function or graft loss. It seems that it can be treated conservatively provided graft perfusion is not jeopardized. The aim of our retrospective clinical study was to assess a long-term course of renal transplant artery stenosis by duplex-Doppler and its influence upon serum creatinine, hemoglobin concentration, and hypertension, as well as to investigate possible association between stenosis and the number of acute rejections. Methods Thirty-four renal transplant recipients, aged 43 ± 13 years, with significant (>50%) renal transplant artery stenosis on Doppler were compared with 34 renal transplant recipients, in whom stenosis was excluded on Doppler; patients of both groups were matched by age, sex, time of transplantation, type of renal transplant and number of previous transplantations. We analyzed peak systolic velocity in renal transplant artery, resistance index at the level of intrarenal arteries, serum creatinine, hemoglobin concentration, blood pressure, number of antihypertensive medications, and number of acute rejections on a yearly basis. Results In the stenosis group, peak systolic velocity was 2.1 ± 0.5 m/s at 1 year after transplantation (controls 1.1 ± 0.4 m/s), 1.9 ± 0.5 m/s at 2 years (0.9 ± 0.4 m/s), 1.9 ± 0.5 m/s at 3 years (0.9 ± 0.4 m/s); resistance index was 62 ± 10% at 1 year (controls 68 ± 7%), 65 ± 9% at 2 years (67 ± 7%), 63 ± 9% at 3 years (67 ± 7); serum creatinine was 128 ± 58 µmol/L at 1 year (controls 129 ± 43 µmol/L), 119 ± 47 µmol/L at 2 years (121 ± 33 µmol/L), 125 ± 54 µmol/L at 3 years (127 ± 32). Conclusion Long-term course of renal transplant artery stenosis (>50%), treated medically or interventionally, seems to be stable and nonprogressive (during 3-year follow-up). Spontaneous regression of stenosis to nonsignificant level is possible. No significant difference in graft function, blood pressure, or the number of acute rejections was observed when comparing the stenotic and nonstenotic group.