Evaluation of the efficacy and safety of endovascular management for transplant renal artery stenosis

Leonardo G.M Valle,Rafael N Cavalcante,Joaquim M Motta-Leal-Filho,Breno B Affonso,Francisco L Galastri,Marisa P Doher,Nadia K Guimarães-Souza,Ana K.N Cavalcanti,Rodrigo G Garcia,Álvaro Pacheco-Silva,Felipe Nasser

doi:10.6061/clinics/2017(12)09

Abstract

OBJECTIVES:To evaluate the safety and efficacy of endovascular intervention with angioplasty and stent placement in patients with transplant renal artery stenosis.METHODS:All patients diagnosed with transplant renal artery stenosis and graft dysfunction or resistant systemic hypertension who underwent endovascular treatment with stenting from February 2011 to April 2016 were included in this study. The primary endpoint was clinical success, and the secondary endpoints were technical success, complication rate and stent patency.RESULTS:Twenty-four patients with transplant renal artery stenosis underwent endovascular treatment, and three of them required reinterventions, resulting in a total of 27 procedures. The clinical success rate was 100%. All graft dysfunction patients showed decreased serum creatinine levels and improved estimated glomerular filtration rates and creatinine levels. Patients with high blood pressure also showed improved control of systemic blood pressure and decreased use of antihypertensive drugs. The technical success rate of the procedure was 97%. Primary patency and assisted primary patency rates at one year were 90.5% and 100%, respectively. The mean follow-up time of patients was 794.04 days after angioplasty.CONCLUSION:Angioplasty with stent placement for the treatment of transplant renal artery stenosis is a safe and effective technique with good results in both the short and long term.

Highlights

Renal transplantation is an important therapeutic option for patients with end-stage chronic kidney disease, and it is associated with increased rates of survival and a better quality of life in these patients [1].certain complications following transplantation may affect the graft and patient survival
Graft dysfunction was defined as delayed graft function in kidney transplants assessed by measuring the creatinine level and estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, while resistant systemic hypertension was defined as blood pressure 4140/ 90 mmHg, despite treatment with antihypertensive drugs
A case of dissection of the common iliac artery with extension to the external iliac artery was diagnosed 30 days after the initial procedure but was resolved with a selfexpanding stent. This retrospective study was carried out to evaluate the impact of endovascular treatment in patients diagnosed with Transplant renal artery stenosis (TRAS), which was proven to be an effective and safe procedure

Summary

Introduction

Renal transplantation is an important therapeutic option for patients with end-stage chronic kidney disease, and it is associated with increased rates of survival and a better quality of life in these patients [1]. Certain complications following transplantation may affect the graft and patient survival. With advances in immunosuppressive drugs, graft loss due to rejection has decreased to rates of 20-30%. Transplant renal artery stenosis (TRAS) is the most common vascular complication that may occur after transplantation, affecting 1-23% of patients [3].

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