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Transplant renal artery stenosis (TRAS) is a significant risk for renal transplantation that can lead to uncontrolled hypertension and/or renal dysfunction with possible allograft loss. Percutaneous transluminal angioplasty and stenting (PTA) is the primary treatment in patients (pts) with TRAS. The purpose of this observational study is to elucidate the technical success, safety and outcomes of PTA for pts with TRAS.
Retrospective review of 19 pts with TRAS referred for PTA was performed. Demographic data, clinical information, creatinine (Cr) levels, transplant implantation information and post PTA success rate, and procedure–related complications were documented and analyzed.
Among 1394 pts who underwent renal transplantation from 2000 to 2012, 19 pts (1.3%) were referred for PTA as the sole treatment for TRAS. Mean age was 49 (SD 11.8); 89% were treated 1–15 months post– transplant with 63% in first six months. Pts presented with refractory hypertension (18/19), worsening renal function (16/19), acute kidney injury after ACE–inhibitor or ARB therapy initiation (3 patients) and new onset or refractory edema (14/19). Median Cr rose from 2.0 mg/dl (IQR 1.7, 2.2) at baseline to 2.9 mg/dl (IQR 2.4, 3.6) at TRAS diagnosis (P–value= 0.0012). Previously reported precipitating factors for TRAS include cadaveric allografts (15/19) and end–to–side anastomosis (19/19). Angiography revealed a kink near the anastomotic site in 6 patients; presence of ostial/proximal anastomotic stenosis in 9 patients while a more distal stenosis was seen in 2 patients. Stenting of 17 renal artery stenosis and 2 critical iliac lesions was performed. Technical success was achieved in all pts and none required repeat procedure. The only complication was puncture site pseudo–aneurysm in 1 patient and no 30–day mortality. Median follow up was 22.5 months (IQR 4.8, 36). The mean Cr pre PTA was 3.2 mg/dl (SD 1.1) declining to 2.2 mg/dl (SD 0.57) post PTA (P value< 0 .0001).
In this single center review, TRAS was seen in 1.3% of renal transplant patients with nearly 2/3 occurring in the first 6 months. PTA was safe and effective with sustained benefit in renal function at intermediate follow up.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Vascular Medicine: Endovascular Therapy IV
Abstract Category: 34. Vascular Medicine: Endovascular Therapy
Presentation Number: 1298M–172
- 2013 American College of Cardiology Foundation