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21 May 2009

Initial experience with renal transplant artery stenosis angioplasty and stenting – it does not confirm antihypertensive or renal function benefit

R Kieszek, K Ostrowski, O Rowiński, M Durlik, A Chmura, M Geremek

Ann Transplant 2009; 14(1): 51-51 :: ID: 880385

Abstract

Background: Transplant renal artery stenosis (TRAS) affects 1-25% of transplant recipients and may lead to allograft loss. The most common presentation is hypertension or elevated serum creatinine concentration (sC); frequently asymptomatic TRAS is seen on routine Doppler US. Objective: To evaluate early results of transplant artery angioplasty in our first referrals from a transplant centre.
Material/Methods: 10 patients (7 male, 3 female, mean age 52.1 years) referred for hypertension (n=3) or elevated sC at various periods post-transplant (4-41 months) were diagnosed with TRAS by Duplex Doppler. All patients underwent balloon angioplasty and 9 had primary stenting. Follow-up ranged from 2 to 21 months with evaluation of arterial blood pressure (ABP), sC, creatinine clearance and the number of antihypertensive drugs taken.
Results: Four patients experienced re-stenosis of the renal transplant artery, three required re-intervention for refractive hypertension. No significant differences were observed pre- and post angioplasty in mean ABP (106.27 vs. 105.36), sC (2.43mg% vs. 2.28m%), creatinine clearance (44.62 vs. 46.9 mL/min) or the number of antihypertensive drugs (3.1 vs. 3.4). There were no graft losses or deaths, dilatation and stent placement were satisfactory at primary angiography in all patients.
Conclusions: Limited experience with a new group of patients does not confirm encouraging results from the other centres in treating hypertension and deteriorating renal graft function secondary to graft's arterial stenosis. A greater number of patients may help to evaluate the impact of endovascular intervention on the long-term graft function, which may be influenced by other factors, such as chronic allograft nephropathy, immunosuppressant  nephrotoxicity etc. Satisfactory angiography result is not necessarily reflected by the clinical course.

Keywords: Kidney Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358