Diagnosis and treatment of early stage transplant renal artery stenosis

Abstract

Objective To summarize the experience of diagnosis and treatment for early stage transplant renal artery stenosis (TRAS). Methods The clinical data of 16 renal transplantation recipients who were diagnosed with TRAS from 2014 January 1st to 2018 August 31st in the Department of Urology, Zhongshan Hospital, Fudan University, were retrospectively analyzed, and 16 renal transplantation recipients without TRAS at the same time were selected as control group. Pair t-test was used to compare the indexes of age, waiting time, serum creatinine, estimated glomerular filtration rate (eGFR), systolic/diastolic blood pressure, graft artery peak systolic velocity (PSV) and resistance index (RI) of segmental arteries, the chi-square test was used to compare the indexes of gender, source of donor kidneys, type of dialysis, different sides of donor kidney, anastomosis method of arteries and occurrence of delayed graft function, the Fisher′s exact probability test was used to compared the indexes of the occurrence of diabetes, hypertension and acute rejection before transplantation. P<0.05 was considered statistically significant. Results Thirteen recipients in TRAS group recieved balloon dilatation, 2 recipients recieved balloon-expandable stent. Up to 2018 August 31st, the function of he transplant kidneys in TRAS group were all stable, except 1 recipient got nephrectomy because of chronic rejection. There was no significant difference for the age, gender, diabetes, hypertension and serum creatinine before transplantation, mean waiting time, source of donor kidneys, type of dialysis, different sides of donor kidney, anastomosis method of arteries, the occurrence of delayed graft function and acute rejection between TRAS group and control group (P all>0.05). Before interventional therapy, the mean serum creatinine, systolic blood pressure and PSV of TRAS group [(5.6±3.5) mg/dL, (144±9) mmHg (1 mmHg=0.133 kPa) and (3.4±1.6) m/s] were all higher than control group [(1.9±0.8) mg/dL, (130±19) mmHg and (1.3±0.5) m/s], the difference was statistically significant (t=3.94, 2.35 and 4.73, P all<0.05), and the mean eGFR and RI of TRAS group [(18±15) mL/min and 0.5±0.1] were all lower than control group [(49±20) mL/min and 0.6±0.1], the difference was statistically significant (t=-4.84, -3.88, P all<0.05). After interventional therapy, the mean serum creatinine, systolic/diastolic blood pressure and PSV of TRAS group [(3.2±1.5) mg/dL, (128±16) mmHg, (76±8) mmHg and (2.0±1.0) m/s] were all lower than pre-treatment, the difference was statistically significant (t=3.63, 4.40, 3.72 and 3.03, P all<0.05), while the mean serum creatinine was still higher than control group [(1.5±0.5) mg/mL], the difference was statistically significant (t=3.93, P<0.05); the mean eGFR and RI of TRAS group [(26±13) mL/min and 0.6±0.1] were all higher than pre-treatment, the difference was statistically significant (t=-4.65 and -3.25, P all<0.05), while the mean eGFR was still lower than control group [(58±17) mL/min], the difference was statistically significant (t=-5.75, P<0.05). Conclusions Screening of color doppler flow imaging could yield a preliminary diagnosis of TRAS. The golden standard for diagnosis relied on graft artery radiography. Interventional therapy can effectively improve the renal function of recipients with TRAS. Key words: Renal transplantation; Transplant renal artery stenosis; Color doppler flow imaging; Diagnosis