Author + information
- Nattawut Wongpraparut1
The transplant renal artery stenosis (TRAS) is still the main limitation after kidney transplant leadings to hypertension, worsening renal function and finally graft loss. Percutaneous transluminal angioplasty/stent(PTA/stent) is an attractive treatment option in patients whom diagnosed with TRAS. We studied to assess clinical presentation and procedural success rate after PTA/stent in TRAS patients.
This is a single center retrospective cohort of patients whom diagnosed with TRAS and have been treated with PTA/stent between January 2001 and October 2016. The procedural success after PTA/stent was pre-specified as 1. renal outcome (reduction of serum creatinine > 15%) and 2. blood pressure outcome (either 2.1 reduction of mean arterial pressure (MAP) > 15% without decreasing of anti-hypertensive medication or 2.2 no reduction or reduction of MAP < 15% with decreasing of anti-hypertensive medication).
Forty-eight TRAS were identified from 861 patients whom had kidney transplant. Mean time from transplantation to TRAS diagnosis was 11.9 months. Majority of them (97.9%) used the end-to-side anastomosis technique. Anastomosis (60%) is most common site of stenosis followed by post-anastomosis (20.7%). The presenting symptoms were worsening renal function (62.5%), accelerated hypertension (12.5%), combined symptoms (18.8%) and pulmonary edema (6.3%). Procedural success in term of renal outcome was 52% within 1 month, 70.8% within 6 months and 64.5% within 1 year. Procedural success in term of BP outcome was 77% within 1 month, 85% within 6 months and 75% within 1 year. Graft survival after PTA was 67% at 1 year, 52% at 2 years.
Clinical presentation and procedural success rate after PTA/stent in TRAS patients were identified. PTA/stent has an acceptable 1-year renal and BP reduction outcome. But long-term survival of the TRAS graft after PTA/stent is still limited.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention