Abstract No. 649 Endovascular management of transplant renal artery stenosis

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Transplant renal artery stenosis (TRAS) occurs in up to 23% of renal transplant recipients, with consequences including refractory hypertension and graft failure. Endovascular treatment options for TRAS include percutaneous transluminal angioplasty (PTA) and stenting. In this study, we compare clinical outcomes of TRAS treated by PTA alone vs. PTA with stenting at a large tertiary referral center performing over 400 renal transplants per year. Thirty adult patients referred for treatment of TRAS between November 2011 and May 2019 were retrospectively reviewed. Indications for angiogram included elevated creatinine, refractory hypertension, graft dysfunction, or elevated renal artery peak systolic velocity. Primary outcomes were reduction in blood pressure (systolic/diastolic) and serum creatinine following intervention. Secondary outcomes included change in peak systolic velocity and intra-arterial pressure gradient. Sixteen patients underwent PTA alone; 14 underwent PTA with stenting (5 drug-eluting, 9 bare-metal). PTA with stenting resulted in statistically significant, sustained drop in systolic blood pressure immediately (11.5%, P = 0.0023), 1 month (7.45%, P = 0.006), and 3 months (12.0%, P = 0.0028) postintervention, but had no significant effect on creatinine at any time point. PTA alone had no significant effect on blood pressure but did result in significant creatinine reduction at 1 month (6.01%, P = 0.005) and 3 months (8.2%, P = 0.014). Baseline creatinine was higher in patients who received PTA alone (2.82 ± 1.33) vs. stenting (1.95 ± 0.68), although the difference was non-significant. No complications were noted in the PTA group; one access complication of common femoral artery pseudoaneurysm occurred in the PTA with stenting group and was treated with thrombin injection. Endovascular treatment of TRAS is safe and effective, with significant, sustained improvement in systolic blood pressure in patients treated with stent placement as compared to PTA alone.