Endovascular treatment for transplant renal artery stenosis: A retrospective cohort study

Transplant renal artery stenosis (TRAS) is the most common (1%–23%) vascular complication following kidney transplantation. The aim of this study was to review our experience with an endovascular approach to treat TRAS. We retrospectively reviewed kidney transplant recipients who underwent percutaneous transluminal angioplasty (PTA) due to TRAS in our institute from January 2009 to December 2015. We analyzed the patient's baseline characteristics, postoperative renal function, blood pressure evolution, and the number of pre- and post-procedure antihypertensive drugs. A total of 21 patients (15 men, 6 women) were treated with the endovascular technique. The predominant presentation was graft dysfunction (76.2%). Stenosis or hemodynamic kinking was located at the anastomosis in 7 (33.3%) patients, proximal to the anastomosis in 13 (61.9%) patients, and distal the anastomosis in 1 (4.8%) patient. PTA without stent placement was performed in 7 patients (33.3%), and PTA with stent placement was performed in 14 patients (67.7%). Serum creatinine levels demonstrated no difference between the pre-procedure level and that on discharge day (1.61 mg/dl [0.47–3.29 mg/dl] vs 1.46 mg/dl [0.47–3.08 mg/dl]; P = .33). The glomerular filtration rate also showed no difference between the pre-procedure value and that on discharge day (53.6 ml/min [22.4–145.7 ml/min] vs 57.0 ml/min [17.56 –145 ml/min]; P = .084). Systolic blood pressure and diastolic blood pressure (DBP) varied from 137 mm Hg (120–160 mm Hg) and 84 mm Hg (70–100 mm Hg) pre-procedure to 129 mm Hg (90–150 mm Hg) and 79 mm Hg (60–90 mm Hg) at discharge, respectively (P = .124 and P = .07). The number of antihypertensive medications significantly decreased from 1.5 (0–6) pre-procedure to 0.5 (0–2) at discharge (P = .023). In our study, there were no technical failures, procedure-related complications or deaths. During the follow-up period, the free-from-reintervention rate was 100%, and graft failures occurred in 2 patients (9.5%) due to rejection. Endovascular procedures for TRAS show a high technical success rate with a low complication rate and a low reintervention rate. PTA showed a trend toward a positive impact on lowering serum creatinine, systolic blood pressure, and diastolic blood pressure and improving estimated glomerular filtration rate, and the number of antihypertensive medications could be significantly reduced after this procedure.