LONG TERM RESULTS OF ENDOVASCULAR STENTING FOR RENAL ARTERY STENOSIS IN KIDNEY TRANSPLANT RECIPIENTS.

Introduction:

Renal artery stenosis (RAS) is one of the known complication post kidney transplantation which can lead to graft dysfunction or hypertension, flash pulmonary edema, hypertensive urgency, emergency, non-resolving pedal edema and hence poor outcome. We present our data of RAS in post kidney transplant patients and their follow up. Along with donor and recipient characteristic, we present time of detection of RAS, efficacy of intervention and graft outcomes.

Methods:

A retrospective analysis was conducted on 34 patients diagnosed with RAS post kidney transplant between 1994 and 2024. Data collection included donor and recipient characteristics, their comorbid conditions, and the timing of RAS detection. The impact of endovascular procedure on blood pressure and serum creatinine levels was observed. Follow-up creatinine and other post-transplant complications were assessed till date.

Results:

The mean (SD) age of donors was 45.07 (12.33) years, with 15 (44.12%) being men. Among total transplants, deceased donor transplants were 6 (17.65%). Donor comorbidities like hypertension was seen in 6 (17.65%) and diabetes mellitus in 2 (5.88%). The mean age of recipients was 45.9 (14.76) years; 29 (85.29%) were men. Among the recipients, 21 (61.76%) had diabetes mellitus and 24 (70.59%) had hypertension. Total ABO incompatible transplants were 6 (17.65%). RAS was detected within median of 5 months (Range 1–120) post-transplant. Out of the 34 patients, 27 (79.41%) underwent stenting. Prior to stenting, the median (IQR) blood pressure medications were 3 (2–4), and median (IQR) serum creatinine level was 1.96 (1.53–2.64) mg/dl. Post-stenting, the blood pressure medications decreased to 2 (1–3) with significant p value (P=0.019), and serum creatinine level improved to 1.32 (1.02–1.81) mg/dl with significant p value (P<0.001). The median follow-up duration was 4.5 (Range 0.5–30) years and follow up creatinine was 1.72 (1.31–3.31) mg/dl. Other complications included chronic humoral rejection seen in 2 (5.88%), cytomegalovirus in 5 (14.71%), BK virus in 1 (2.94%), and recurrence of native kidney disease (FSGS) in 1 (2.94%) patient. The number of patients shifted on dialysis was 2 (5.88%) and other 2 (5.88%) patients died during follow-up. Longest follow-up duration was 30 years and shortest follow-up was 6 month.

Conclusions:

RAS is a complication among kidney transplant recipients, causing graft dysfunction and high blood pressure. Early detection and timely intervention, including endovascular procedure like stenting, was effective in managing RAS, better blood pressure control with fewer antihypertensive drugs and resulted in stable allograft function on long term follow-up.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.