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04 February 2020 : Original article  

Diagnosis and Treatment of Renal Artery Stenosis in China in the Era of Donation After Cardiac Death

Qiang Wang1ABCD, Xiaoli Li2ABCD, Zhijia Liu3ABCD, Junnan Xu3B, Yong Han3B, Tao Yu3C, Song Chen4C, Yuzhe Tang4D, Yubao Liu4D, Xiang Li3AEFG*

DOI: 10.12659/AOT.918076

Ann Transplant 2020; 25:e918076

Abstract

BACKGROUND: The aim of this study was to investigate the clinical features and treatment strategies of transplant renal artery stenosis (TRAS) with kidneys from donation after cardiac death (DCD).

MATERIAL AND METHODS: We collected the clinical data of donors and recipients of single-center DCD-induced TRAS from January 2015 to June 2017.

RESULTS: All the 8 cases of TRAS were from hypertensive cerebrovascular accident DCD-originated kidneys. The mean donor age was 53.5 (45~57) years, with mean BMI 27.8 (26.4~32.3) kg/m², atherosclerosis index 5.8 (4.9~7.0), and renal atherosclerotic plaque. Clinical features of TRAS were: refractory hypertension with elevated serum creatinine >50%, and negative urine protein and occult blood. Ultrasound of transplanted kidneys showed renal blood flow index 0.49 (0.43~0.55). Angiography confirmed the diagnosis of renal artery trunk or secondary branch stenosis. There were 2 cases of moderate stenosis and 6 cases of severe stenosis. Six patients underwent stent implantation and 2 patients underwent balloon dilatation. Seven patients had serum creatinine recovery after interventional therapy during follow-up. The transplanted kidney of 1 patient ruptured 6 h after interventional therapy and was then resected.

CONCLUSIONS: The incidence of TRAS with hypertensive cerebrovascular accident DCD-originated kidneys is relatively high, which is a warning to kidney transplant physicians. Digital subtraction angiography (DSA) is the most reliable diagnostic means of TRAS and can be performed concurrently with intervention therapy. If the donor has severe atherosclerosis, plaques that are visible to the unaided eye in the renal artery trunk should be removed as completely as possible.

Keywords: atherosclerosis, Hypertension, Kidney Transplantation, Renal Artery Obstruction, Angiography, Digital Subtraction, Creatinine, Kidney, Postoperative Complications, young adult

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