Introduction:
Transplant renal artery stenosis (TRAS) is a well-recognized, potentially curable cause of posttransplant arterial hypertension and graft dysfunction, affecting 1 %to 23% of the recipients. It is associated with poor outcomes, including transplant loss and death, but is potentially amenable to intervention with endovascular revascularization.
Aim: This study aims to study the incidence, clinical presentation, and outcome of TRAS in renal allograft recipients.
Methods:
This retrospective study was done at the Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India, from January 1982 to October 2022. Demographic data and post-transplant evaluation were studied, including delayed graft dysfunction, acute rejection, cytomegalovirus status, blood pressure profile, oedema and graft function. Laboratory and investigation data were analysed, including serum creatinine, potassium, Doppler transplant renal artery, and angiogram. All the patients underwent graft angiography and underwent angioplasty with stenting if the stenosis was more than 80%. The renal function, Blood pressure reading and need for anti-hypertensive medications were recorded post-stenting. All the recipients followed up after 1 month post stenting and 4 monthly thereafter
Results:
Sixty-seven of 3420 (1.9%) renal allograft recipients had confirmed TRAS. The median time to TRAS was 2.8 months (0.24 to 228 months) post-transplantation. Predominantly male 58/67(86.6%), with average age 39.01±11.8 years. Increasing BP (31.4%), worsening allograft dysfunction (22.3%), worsening of BP with graft dysfunction (40.3%) and swelling (5.9%) were predominant presenting features. Thirteen of 67 (19.4%) had Diabetes, Five of 67(7.5%) had Ischaemic heart disease, and Seven of 67(10.4%) had Acure cellular rejection in the past. All patients were treated with percutaneous transluminal angioplasty with stenting. Renal function improved post-angioplasty & stenting in 22/67(32.8%) and stabilised in 40/67(59.7%). Creatinine levels were (1.81 ±1.06 mg (baseline) ,1.35±0.45mg (1 month),1.34±0.71mg (6 months) and 1.46±1.16mg (12 months). 10-year graft survival post angioplasty and stent was 78%. Among those five recipients who worsened, 3 had fungal infections, and two had IFTA and lost their grafts. Three had bleeding at the femoral site, and two had a pseudoaneurysm at the puncture site.
Conclusions:
The incidence of TRAS in the study was 1.9%. Early suspicion clinically and detection by Doppler studies and timely intervention by stenting improves hypertension, reduce allograft dysfunction, and improve graft survival.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.