POS-192 TRANSPLANT RENAL ARTERY STENOSIS: EPIDEMIOLOGIC PROFILE AND THERAPEUTIC PARTICULARITIES

Abstract

Transplant renal artery stenosis (TRAS) is a serious complication that might occur at any time during the postoperative period. It is a serious predictor of graft loss. The purpose of our study was to identify the epidemiologic profile of TRAS, and to analyze the therapeutic particularities as well as the patients’ evolving profil. All cases of TRAS noted in the follow up of our patients from 1970 to 2019 were reviewed retrospectively in our transplantation department. A total of 10 patients (7 men, 3 women) were diagnosed with TRAS, with a median age of 37 (32-69 years). The original nephropathy was glomerular in four cases, reno-vascular and chronic interstitial in respectively four and two case. Seven patients received renal grafts from living donors, while the three others received allografts from brain-deceased patients. In all patients, end-to-side anastomosis was performed. The median time to presentation was 240 days. Seven patients presented during the early post-transplantation process (<15 days). Clinical presentation was delayed graft function in three cases, secondary graft function deterioration in two case and acute hypertension in five cases. The nadir post-transplant serum creatinine level was 240 mmol/L (103-300 mmol/L), while the serum creatinine value at admission was 415 mmol/L (132-1061 mmol/L). The stenosis was anastomotic in eight case and pre-anastomotic in the two other cases. The stenosis was diagnosid by Doppler ultrasound in all patients, and was significant (superior to 70%) in four cases: three treated by renal artery angioplasty, the last one managed with surgical revascularization for technical difficulty. An optimal medical management was indicated in the other six cases. Serum creatinine levels decreased in nine cases while no amelioration was noted in the last surgical managed one. We have observed three renal artery in-stent restenosis after 10 monthes of evolution. The median last serum creatinine level was 215 mmol/L (97-600 mmol/L). TRAS may be a curable cause of refractory hypertension and allograft dysfunction. An early diagnosis and appropriate treatment can prevent graft loss.