Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report

Laterality in laparoscopic hand assisted donor nephrectomy - Does it matter anymore? Outcomes of a large retrospective series

This retrospective study was performed to analyse if laterality of the retrieved living donor kidney had any effect on donor and recipient outcomes after hand assisted laparoscopic donor nephrectomy (HALDN). 739 donors who underwent HALDN between January 2006 and January 2018 at a large tertiary transplant centre in the United Kingdom were included. Donor outcomes in individuals undergoing right versus left HALDN were compared with respect to conversion rates, morbidity, warm and cold ischaemia times and recipient failure rates, vascular and ureteric complications. 604 (81.7%) underwent left HALDN and 135 (18.3%) underwent right HALDN, mean age was 47.1 years and 46.8 years respectively with comparable gender distribution. The operative time was shorter for the left side (p = 0.003) and improved during the study for the left but not the right side. In recipients who received left kidneys there were more early technical failures observed (8 versus 1) though not statistically significant. Most centres prefer performing a left nephrectomy and recipient surgeons prefer a left kidney for transplantation primarily because of having a longer vein. This large study provides reassurance that right HALDN nephrectomy is a safe procedure with similar outcomes to left HALDN.

Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis

BACKGROUND

Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered.

METHODS

Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS.Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.

Spontaneous recanalization of occluded transplant renal artery: a rare case report

Background

Transplant renal artery stenosis (TRAS) is a serious vascular complication that occurs after renal transplantation and can result in hypertension, renal functional impairment, and graft loss. Endovascular treatment has become the first-line treatment for TRAS because of its low invasiveness and high success rate.

Case presentation

A 23-year-old female with end-stage renal disease of unknown cause received a living-donor kidney transplantation 10 months ago. Seven months after the transplantation, her blood pressure gradually deteriorated. Magnetic resonance angiography revealed bending and stenosis of the transplant renal artery, and the patient received endovascular treatment. A digital subtraction angiography revealed significant stenosis of 95% in the proximal transplant renal artery. The guidewire could not pass through the stenotic segment of the transplant renal artery even with repeated attempts by the surgeons; as a result, the transplant renal artery became occluded, and vasodilators were ineffective. After the operation, renal function gradually worsened, so she began to receive regular dialysis. Twenty-five days later, the patient’s urine volume was significantly higher than that before, and ultrasound showed that the proximal transplant renal artery was not completely occluded. A re-intervention was performed, and the stent was placed successfully in the stenotic segment. After the operation, renal function gradually recovered, and dialysis was no longer needed.

Conclusion

Patients with iatrogenic transplant renal artery occlusion may have the possibility of spontaneous recanalization, which can help prevent the need for re-transplantation.

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

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/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.

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study

Background

Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter.

Method

The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter.

Results

R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150–0.5083 and 0.0863–0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants (p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men (p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys (p = 0.3123). Spearman’s coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled − 0.36.

Conclusion

The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.