Percutaneous Transluminar Angioplasty and Stenting of Post Transplant Renal Artery Stenosis(TRAS): Monocentric Experience.

Abstract

Introduction We retrospectively evaluated the occurrence of post transplant renal artery stenosis (TRAS) in 808 recipients of a cadaveric renal transplantation performed in our unit between 1991 and 2013 and the outcome after a percutaneous revascularization. Materials TRAS was diagnosed when a Peak systolic Velocity(PSV) > 2.5 m/sec was found in the graft renal artery by Doppler ultrasound. Subsequently an angiography and eventually a percutaneus transluminal angioplasty (PTA) with stenting was performed. We compared renal function, blood hypertension, PSV and Resistive index (RI) at the time of the diagnosis of TRAS with the values collected at the last follow up visit. Results We found 74 (8.9%) TRAS of whom 18 due to a kinking of the artery or a non hemodinamic stenosis (defined as PSV between 2.0 and 2.5 m/sec) that didn't require angiography. 56 patients underwent an angiography. In 4 cases the stenosis was not confirmed, 51 were treated with PTA with stenting and one only with PTA without stenting. The median of the time between the diagnosis of TRAS and the renal transplantation was 70 days (range 2-3347 days). TRAS occurred near the anastomosis in 60% of the cases. We observed 1 hemorragic complication during the procedure (1.9%) that required an urgent nephrectomy. A restenosis was found in 8 cases (17%) treated again with a PTA in 4 patients, PTA and stenting in 2, and with medical therapy in 2. With a mean follow up of 5±4 years we confirmed the reduction of PSV, blood pressure and serum creatinine and an increase of RI and GFR as show in table 1.Table: No Caption available.Conclusions TRAS was found in 8.9% of our cohort of transplanted patients. The angiography is useful to confirm the diagnosis made by doppler examination and eventually treat the lesion