Outcomes of Endovascular Interventions for Salvage of Renal Transplant Allografts

Abstract

As renal transplantation has been performed with increased frequency, interventions to preserve graft function and integrity have been steadily increasing. This study examines the outcomes of endovascular therapy based on indication for renal allograft salvage. A prospective transplant registry was queried for all patients undergoing endovascular interventions for transplant allograft salvage from 2002 to 2011. Demographics, perioperative data, and transplant function outcomes were extracted and analyzed. Among 34 renal transplant recipients who underwent endovascular interventions for graft salvage, the mean age was 48.2 years (18-74 years), and 62% were men. The indications for intervention included worsening serum creatinine (n = 15), renovascular hypertension (n = 11), and structural abnormalities identified on noninvasive imaging (n = 8). Transluminal angioplasty, with or without stenting, was done in 26 patients: 14 (41.2%) with significant transplant stenosis, 11 (32.4%) with peripheral arterial disease (PAD) in proximal iliac vessels, and one with iliac dissection. Five arteriovenous fistulae and two pseudoaneurysms required embolization. One patient had deep venous thrombosis causing obstruction of allograft outflow requiring lysis. There were no periprocedural deaths, and 30-day morbidity was 17.6%. Of patients with worsening renal function, 67% had improvement or stabilization of their renal function. Interestingly, only 36% of patients with renovascular hypertension showed improvement. Mean follow-up was 4.2 years. There were no significant differences in transplant allograft survival over the duration of follow-up based on indication for endovascular intervention (Fig; log-rank test P = .03). Endovascular salvage of renal allograft transplants can be safely done for various indications, although patients with renovascular hypertension were less likely to improve. Despite differences in symptomatic outcome, the indication for initial intervention does not significantly influence the long-term transplant graft survival.