Diagnosis and Treatment of Early Transplant Renal Artery Stenosis: Experience From a Center in Eastern China

Abstract

Few studies have focused on the clinical characteristics of transplant renal artery stenosis (TRAS) with early onset. Sixteen cases diagnosed with TRAS in our center from January 2014 to August 2018 were retrospectively analyzed. Sixteen transplant patients without TRAS were selected as controls. The median diagnostic time for TRAS was 47.5 days after transplantation. No significant difference was observed between the TRAS group and the control group. The serum creatinine level (Scr), estimated glomerular filtration rate, systolic/diastolic blood pressure, graft artery peak systolic velocity (PSV), and resistive index of intersegmental artery (RI-ISA) between the 2 groups were (5.55 ± 3.49) and (1.89 ± 0.85) mg/dL; (17.83 ± 14.94) and (49.39 ± 19.96) mL/min; (143.50 ± 9.49)/(86.14 ± 7.38) and (130.38 ± 18.86)/(82.81 ± 12.52) mm Hg; (3.39 ± 1.57) and (1.31 ± 0.51) m/s; and (0.51 ± 0.10) and (0.67 ± 0.13), respectively. All showed statistical significance except the diastolic blood pressure. The Scr, estimated glomerular filtration rate, systolic/diastolic blood pressure, graft artery PSV, and RI-ISA in the TRAS group prior and after treatment were (5.55 ± 3.49) and (3.20 ± 1.50) mg/dL; (17.83 ± 14.94) and (25.60 ± 13.29) mL/min; (143.50 ± 9.49)/(86.14 ± 7.38) and (128.07 ± 16.16)/(75.71 ± 7.56) mm Hg; (3.39 ± 1.57) and (2.00 ± 1.04) m/s; and (0.51 ± 0.10) and (0.61 ± 0.10); all showed statistical significance. Receiver operating characteristic analysis showed an area under curve of 0.8616 for PSV and 0.8535 for RI-ISA in diagnosing TRAS. Patients with TRAS in our center showed a unique characteristic of early onset. The most prominent clinical symptom of TRAS is increasing Scr level instead of refractory hypertension. Screening of color Doppler flow imaging with a graft artery PSV >2.5 m/s and RI-ISA <0.5 could yield a preliminary diagnosis of TRAS. Percutaneous transluminal angioplasty/stenting could effectively improve allograft function as well as color Doppler flow imaging indexes.