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Transplant Renal Artery Stenosis: Underrecognized, Not So Rare, but Curable Complication. Transplant Proc 2022; 54:976-980. [DOI: 10.1016/j.transproceed.2022.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
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Gunawardena T, Sharma H, Elmghrbee A, Mehra S. Endovascular Treatment for Transplant Renal Artery Stenosis Improves the Short- and Long-Term Graft and Patient Outcomes. EXP CLIN TRANSPLANT 2022; 20:253-257. [PMID: 35352631 DOI: 10.6002/ect.2021.0476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Transplant renal artery stenosis is the commonest vascular complication after kidney transplant. This study aimed to evaluate the efficacy of endovascular treatment for patients with clinically significant transplant renal artery stenosis. MATERIALS AND METHODS Electronic patient records of kidney transplant recipients who received transplants from October 1, 2010, to July 31, 2021, at the Royal Liverpool University Hospital were retrospectively reviewedtoidentify thosewhounderwent endovascular treatment for transplant renal artery stenosis. Analysis of variance and paired sample t tests were respectively used to compare serum creatinine and the mean number of antihypertensive medications before and aftertreatment. RESULTS During the period of analysis, there were 1211 kidney transplant recipients, with 33 (2.72%) who received endovascular treatment for transplant renal artery stenosis. Mostofthesepatientsweremen(25/33), and the median age was 59 years (range, 27-83 y). The mean follow-up duration was 69.82 months. As primary treatment, 19/33 patients (57.6%) were treated with percutaneous balloon angioplasty and 14/33 (42.4%) received stents. Procedure-related complications occurred in 3 patients (9.1%; 2 had false aneurysms, 1 had renal artery dissection). Significant improvements in mean serum creatinine levels were shown up to 4 years after the procedure (P = .019). A significant difference in the mean number of antihypertensive drugs before and after treatment was noted in those who had resistant hypertension as a presentation for transplantrenal artery stenosis (P = .016). At the end of follow-up, 7 patients (21.1%) had graft failure, with 1 patient (3.0%) having graft failure as a direct consequence of transplant renal artery stenosis. There was no reported incidence of patient mortality. CONCLUSIONS Endovascular treatment for transplant renal artery stenosis provides a sustained improvement in graft function and a significant reduction in antihypertensive drug requirement.
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Affiliation(s)
- Thilina Gunawardena
- From the Department of Transplant and Vascular Access Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
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Assessment and management of transplant renal artery stenosis. A literature review. Ann Vasc Surg 2022; 82:13-29. [PMID: 35108560 DOI: 10.1016/j.avsg.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND transplant renal artery stenosis (TRAS) following kidney transplantation is a possible cause of graft failure. This review aimed to summarize the evidence about physiopathology, diagnosis and early and late effectiveness of the endovascular treatment (EVT), including angioplasty and stenting procedures. METHODS a literature research was performed using Pubmed, Scopus and the Cochrane Library databases (January 2000 to September 2020) according to PRISMA guidelines. Studies were included if they describe EVT, percutaneous transluminal angioplasty or stent placement of TRAS, published in English and with a minimum of ten patients. RESULTS 56 studies were included. TRAS incidence ranges from 1% up to 12% in transplanted kidneys. The TRAS risk factors were: elderly donor and recipient, cytomegalovirus match status, Class II Donor Specific Antibodies (DSA), expanded donor criteria, delayed graft functioning and other anatomical and technical factors. The highest frequency of TRAS presentation is after 3-6 months after kidney transplantation. The most frequent localization of stenosis was para-anastomotic (ranging from 25% to 78%). In 9 studies, all patients were treated by percutaneous transluminal angioplasty (PTA), in 16 studies all patients received percutaneous transluminal stenting (PTS) and in 21 series patients received either PTA or PTS. The Twelve months patency rates after EVT ranged from 72% to 94%. The overall complication rate was 9%, with pseudoaneurysms and hematomas as most frequent complications. CONCLUSION TRAS can be successfully and safely treated through an endovascular approach. Stent delivery seems to guarantee a higher patency rate compared to simple angioplasty, however further studies are needed to confirm these results.
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Hinojosa-Gonzalez DE, Salgado-Garza G, Torres-Martinez M, Villegas-De Leon SU, Bueno-Gutierrez LC, Herrera-Carrillo FE, Gonzalez-Urquijo M, Segura Ibarra V, Fabiani MA, Flores-Villalba E. Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis. J Endovasc Ther 2021; 29:294-306. [PMID: 34399594 DOI: 10.1177/15266028211038593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. METHODS A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. RESULTS Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17-1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40-0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29-14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29-1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41-251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14-0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75-1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. CONCLUSION The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.
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Affiliation(s)
| | - Gustavo Salgado-Garza
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | | | | | | | | | | | - Victor Segura Ibarra
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico.,Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Monterrey, NL, Mexico
| | | | - Eduardo Flores-Villalba
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, NL, Mexico.,Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Monterrey, NL, Mexico
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Ren Y, Xiong F, Kan X, Qian K, Cao Y, Chen L, Xiong B, Zhou G, Zheng C. Endovascular management of transplant renal artery stenosis: A single-center retrospective study. Catheter Cardiovasc Interv 2019; 95:429-436. [PMID: 31802623 DOI: 10.1002/ccd.28624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/22/2019] [Accepted: 11/17/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim is to evaluate the efficacy and complications of percutaneous transluminal angioplasty (PTA)/stenting in the treatment of transplant renal artery stenosis (TRAS). BACKGROUND TRAS is a relatively rare condition, and currently, there is not enough study about interventional therapy for TRAS. METHODS Between April 2011 and July 2018, 33 patients with TRAS underwent interventional therapy. Analysis of parameters was as follows: technical success, pretreatment and posttreatment serum creatinine, and blood pressure, and vessel patency via ultrasound at 1, 6, and 12 months posttreatment and once a year thereafter. RESULTS One procedure failed. The success rate of PTA/stenting placement was 97.0%. Fourteen PTAs with 16 stents were primary interventions, with 2 stent procedures performed subsequently due to restenosis; the restenosis rate was 6.3%. During the follow-up period, two patients progressed to graft renal failure and three patients were lost to follow-up. The rest of the patients still had stable graft function and blood pressure. Compared with preoperative conditions, blood pressure and serum creatinine significantly decreased (p < .05). No treatment-related deaths or serious complications occurred. CONCLUSIONS PTA/stenting is a safe and effective treatment for TRAS. For selected TRAS patients, PTA or PTA with stent may achieve good therapeutic outcomes. Selecting appropriate puncture pathways may help improve the success rate and affect the operation results, and open surgery may be avoided.
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Affiliation(s)
- Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fu Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Kun Qian
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanyan Cao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Guofeng Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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Long-term Outcomes after Transplant Renal Artery Stenosis Surgery. Ann Vasc Surg 2019; 54:261-268. [DOI: 10.1016/j.avsg.2018.05.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/12/2018] [Accepted: 05/21/2018] [Indexed: 12/23/2022]
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Dickey KW, Durrani RJ. Does Endovascular Intervention for Transplant Renal Artery Stenosis Improve Outcomes at 10 Years? Radiology 2018; 290:564-565. [PMID: 30398441 DOI: 10.1148/radiol.2018182252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin W Dickey
- From the Department of Radiology, Interventional Radiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157
| | - Raisa J Durrani
- From the Department of Radiology, Interventional Radiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157
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Patel U, Kumar S, Johnson OW, Jeon JH, Das R. Long-term Graft and Patient Survival after Percutaneous Angioplasty or Arterial Stent Placement for Transplant Renal Artery Stenosis: A 21-year Matched Cohort Study. Radiology 2018; 290:555-563. [PMID: 30398440 DOI: 10.1148/radiol.2018181320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare long-term graft and patient survival after percutaneous angioplasty (PTA) or stent placement for transplant renal artery stenosis (TRAS) with a control cohort without TRAS. Materials and Methods This is a retrospective matched cohort study of 41 patients (median age, 49 years; range, 18-72 years), including 27 male patients (median age, 48 years; range, 18-67 years) and 14 female patients (median age, 52 years; range, 24-68 years), with TRAS from December 1995 through 2016. Primary end points were death-censored graft and patient survival, compared by using log-rank test and Cox proportional regression. Secondary outcomes were improvement in renal function, blood pressure (BP), and complications. Results Twenty-four patients underwent PTA and 17 received stent placements. Ten-year graft survival was 92.1% (range, 83.2%-100%) versus 81.4% (range, 67.8%-95.3%) (P = .56), and 10-year patient survival was 89.9% (79.1%-100%) versus 84.7% (72.1%-97.5%) (P = .49), for the study and control groups, respectively. Five patients (12%) resumed dialysis in each group and a total of 17 patients died (eight in the study group and nine in the control group). Most patients died with a functioning graft (seven of eight in the study group and seven of nine in the control group). Posttreatment median systolic and diastolic BP improved by 12% and 7.4%, respectively, and serum creatinine improved by 27%. Normal systolic BP and serum creatinine level at 1 year after treatment were associated with better survival for patients (P = .04; hazard ratio [HR], 1.04; 95% confidence interval [CI]: 1.0, 1.075) and grafts (P < .001; HR, 1.02; 95% CI: 1.0, 1.027). Other covariates, including PTA versus renal stent placement, intra-arterial pressure gradient greater than 10%, diastolic BP, age at transplantation, sex, graft type, rejection, and delayed graft function, were not significant. Five patients (12.2%) had a complication (Society of Interventional Radiology class A, two of 41 [4.9%]; class B, two of 41 [4.9%]; and class D, one of 41 [2.4%]); 30-day graft loss and patient mortality were zero. Conclusion Long-term graft and patient survival after endovascular correction of transplant renal artery stenosis (TRAS) was similar to that without TRAS and most patients avoided returning to dialysis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Dickey and Durrani in this issue.
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Affiliation(s)
- Uday Patel
- From the Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust and Medical School, Blackshaw Road, London SW17 0QT, England (U.P., R.D.); Centre for Medical Imaging, University College London, London, England (S.K.); Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, England (O.W.J.); and Department of Radiology, Royal Sussex County Hospital, Brighton, England (J.H.J.)
| | - Shankar Kumar
- From the Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust and Medical School, Blackshaw Road, London SW17 0QT, England (U.P., R.D.); Centre for Medical Imaging, University College London, London, England (S.K.); Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, England (O.W.J.); and Department of Radiology, Royal Sussex County Hospital, Brighton, England (J.H.J.)
| | - Oscar William Johnson
- From the Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust and Medical School, Blackshaw Road, London SW17 0QT, England (U.P., R.D.); Centre for Medical Imaging, University College London, London, England (S.K.); Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, England (O.W.J.); and Department of Radiology, Royal Sussex County Hospital, Brighton, England (J.H.J.)
| | - Justyn Hwee Jeon
- From the Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust and Medical School, Blackshaw Road, London SW17 0QT, England (U.P., R.D.); Centre for Medical Imaging, University College London, London, England (S.K.); Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, England (O.W.J.); and Department of Radiology, Royal Sussex County Hospital, Brighton, England (J.H.J.)
| | - Raj Das
- From the Department of Interventional Radiology, St George's University Hospitals NHS Foundation Trust and Medical School, Blackshaw Road, London SW17 0QT, England (U.P., R.D.); Centre for Medical Imaging, University College London, London, England (S.K.); Department of Vascular Surgery, Guy's and St Thomas' Hospital, London, England (O.W.J.); and Department of Radiology, Royal Sussex County Hospital, Brighton, England (J.H.J.)
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Chen LX, De Mattos A, Bang H, Vu CT, Gandhi M, Alnimri M, Gallay B, Fananapazir G. Angioplasty vs stent in the treatment of transplant renal artery stenosis. Clin Transplant 2018; 32:e13217. [DOI: 10.1111/ctr.13217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Ling-Xin Chen
- Section of Transplant Nephrology; Department of Medicine; University of California Davis School of Medicine; Sacramento CA USA
| | - Angelo De Mattos
- Section of Transplant Nephrology; Department of Medicine; University of California Davis School of Medicine; Sacramento CA USA
| | - Heejung Bang
- Division of Biostatistics; Department of Public Health Sciences; University of California Davis School of Medicine; Sacramento CA USA
| | - Catherine T. Vu
- Department of Radiology; University of California Davis School of Medicine; Sacramento CA USA
| | - Mehul Gandhi
- Section of Transplant Nephrology; Department of Medicine; University of California Davis School of Medicine; Sacramento CA USA
| | - Muna Alnimri
- Section of Transplant Nephrology; Department of Medicine; University of California Davis School of Medicine; Sacramento CA USA
| | - Brian Gallay
- Section of Transplant Nephrology; Department of Medicine; University of California Davis School of Medicine; Sacramento CA USA
| | - Ghaneh Fananapazir
- Department of Radiology; University of California Davis School of Medicine; Sacramento CA USA
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Unique Considerations When Managing Hypertension in the Transplant Patient. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016. [PMID: 27815930 DOI: 10.1007/5584_2016_87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
For the select fortunate recipients of organ transplants, transplantation affords the rare opportunity for a new life. Given the scarcity of organs for transplantation, it is imperative that the health of transplant recipients be optimized in order to fully benefit from this gift of life. Unfortunately, hypertension is highly prevalent in the transplant population and it is considered a major cardiovascular risk factor contributing to mortality and morbidity in this population. In this chapter, we expound on the epidemiology, unique pathophysiology, evaluation, and management of hypertension as it pertains to the solid organ transplant recipient. In addition, a brief commentary is made on the subject of hypertension following living kidney donation, and practical aspects of management of hypertension in the solid organ recipient are summarized at the end of the chapter.
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Kolli KP, LaBerge JM. Interventional Management of Vascular Renal Transplant Complications. Tech Vasc Interv Radiol 2016; 19:228-36. [PMID: 27641457 DOI: 10.1053/j.tvir.2016.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Renal transplantation is the therapy of choice in patients with end stage renal disease. Although transplant rejection remains the most common complication after renal transplantation, vascular anatomical complications occur in 1%-23% of renal transplant recipients. Interventional radiologists play an important role in the management of these complications. This review discusses the role of image-guided interventions within the context of multidisciplinary patient management. Particular emphasis is given to anatomical considerations unique to this patient population, techniques used for image-guided interventions, and outcomes of image-guided interventions.
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Affiliation(s)
- Kanti Pallav Kolli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
| | - Jeanne M LaBerge
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
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