NATIVE PERIPHERAL VASCULAR DISEASE CONTRIBUTES TO RENAL TRANSPLANT RENOVASCULAR DISEASE

Abstract

288 Renal transplant artery stenosis (RTAS) is a relatively rare complication of renal transplantation, especially with the current techniques for vascular anastomoses. However, older patients (pts) prone to peripheral vascular disease (PVD), are more frequently being considered as candidates for renal transplantation. PVD involving the iliac system in this context can mimic RTAS(pseudoRTAS) and detrimentally affect graft function. We retrospectively analyzed 819 pts who underwent primary and non-primary kidney transplantation alone between 1993 and 1997 to determine the extent of pseudoRTAS. The population consisted of 506 M and 313 F. 92 pts (11.2%), suspected of having RTAS with new onset lower extremity edema and an increase in serum creatinine(Cr) underwent angiography (Agram) or magnetic resonance angiography (MRA). 4 pts underwent Agram or MRA involving the transplant renal artery for other reasons. RTAS or pseudoRTAS was defined as one or more hemodynamically significant lesions in the renal transplant artery or iliac system diagnosed by Agram or MRA. PseudoRTAS or RTAS was evident in 44 pts (5.4%), including 5 pts with pseudoRTAS and RTAS, 15 with pseudoRTAS, and 24 with RTAS. The recipient factor most significantly associated with RTAS and pseudoRTAS was increased weight at time of transplant (p < 0.0009). Other recipient factors that were associated with RTAS or pseudoRTAS included:TableThere was no significant association between RTAS or pseudoRTAS and race, pre-transplant dialysis modality, use of cyclosporine, FK506 or MMF, CMV infection, PRA, or HLA matching. In evaluating donor variables, available for 491 cadaveric transplants in this group, only older donor age was significantly associated with RTAS or pseudoRTAS (p < 0.0005). These data suggest that ischemic renal disease in renal transplant recipients may be increasing in incidence, taking on a new guise encompassing RTAS and pre-existing PVD that acts as pseudoRTAS.