Vascular and Interventional Radiology

Renal Arterial Stenosis in Renal Allografts: Retrospective Study of Predisposing Factors and Outcome after Percutaneous Transluminal Angioplasty

Abstract

PURPOSE: To determine the predisposing factors to transplant renal arterial stenosis (TRAS) and assess the outcome of percutaneous transluminal angioplasty (PTA) as the primary treatment.

MATERIALS AND METHODS: Of 831 renal allograft recipients (584 cadaveric, 247 living related) between January 1991 and December 1998, 72 had hypertension and/or renal dysfunction. All 72 underwent arteriography, and their medical charts were retrospectively reviewed.

RESULTS: Prevalence of TRAS was 3.1% (26 of 831). Technical success rate of PTA was 94% (16 of 17), and clinical success rate was 82% (14 of 17). Those with renal dysfunction had a mean pre-PTA creatinine value of 2.6 mg/dL (230 μmol/L) ± 0.5 (SD) versus a 1-week post-PTA value of 1.7 mg/dL (150 μmol/L) ± 0.3 (P < .001). Of those with hypertension, all but one had substantial improvement in mean diastolic blood pressure. At 26.9 months mean follow-up in 16 patients with successful PTA, two stenoses reoccurred, and two grafts were lost to chronic rejection. TRAS was present in 14 of 45 end-to-side anastomoses and 12 of 27 end-to-end anastomoses (P = .31), and TRAS was more prevalent in cadaveric grafts (24 of 584) than in living related grafts (two of 247). In cadaveric grafts, the mean cold ischemia time was 29.0 hours ± 6.9 in those with TRAS (n = 24), as compared with 25.5 hours ± 8.1 in those with no TRAS (n = 39; P = .35). Seven of 17 patients with acute rejection and six of 35 with chronic rejection had TRAS.

CONCLUSION: Primary treatment of TRAS with PTA has good intermediate-term results. TRAS is more prevalent in cadaveric allografts with long cold ischemia time.

References

1 Fervenza FC, Lafayette RA, Alfrey EJ, Petersen J. Renal artery stenosis in kidney transplantation. Am J Kidney Dis 1998; 31:142-148. Crossref, Medline, Google Scholar
2 Faenza A, Spolaore R, Poggioli G, Selleri S, Roversi R, Gozzetti G. Renal artery stenosis after renal transplantation. Kidney Int Suppl 1983; 14:S54-S59. Google Scholar
3 Lo CY, Cheng IK, Tso WK, Mak KO. Percutaneous transluminal angioplasty for transplant renal artery stenosis. Transplant Proc 1996; 28:1468-1469. Medline, Google Scholar
4 Lacombe M. Arterial stenosis complicating renal allotransplantation in man: a study of 38 cases. Ann Surg 1975; 181:283-288. Crossref, Medline, Google Scholar
5 Becker BN, Odorico JS, Becker YT, et al. Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. Clin Transplant 1999; 13:349-355. Crossref, Medline, Google Scholar
6 Wong W, Fynn SP, Higgins RM, et al. Transplant renal artery stenosis in 77 patients: does it have an immunological cause?. Transplantation 1996; 61:215-219. Crossref, Medline, Google Scholar
7 Moresco KP, Patel NH, Namyslowski J, Shah H, Johnson MS, Trerotola SO. Carbon dioxide angiography of the transplanted kidney: technical considerations and imaging findings. AJR Am J Roentgenol 1998; 171:1271-1276. Crossref, Medline, Google Scholar
8 Halimi JM, Al-Najjar A, Buchler M, et al. Transplant renal artery stenosis: potential role of ischemia/reperfusion injury and long-term outcome following angioplasty. J Urol 1999; 161:28-32. Crossref, Medline, Google Scholar
9 Gray DW. Graft renal artery stenosis in the transplanted kidney. Transplant Rev 1994; 8:15-21. Crossref, Google Scholar
10 Kuo PC, Petersen J, Semba C, Alfrey EJ, Dafoe DC. CO2 angiography: a technique for vascular imaging in renal allograft dysfunction. Transplantation 1996; 61:652-654. Crossref, Medline, Google Scholar
11 Luk SH, Chan JH, Kwan TH, Tsui WC, Cheung YK, Yuen MK. Breath-hold 3D gadolinium-enhanced subtraction MRA in the detection of transplant renal artery stenosis. Clin Radiol 1999; 54:651-654. Crossref, Medline, Google Scholar
12 Mell MW, Alfrey EJ, Rubin GD, Scandling JD, Jeffrey RB, Dafoe DC. Use of spiral computed tomography in the diagnosis of transplant renal artery stenosis. Transplantation 1994; 57:746-748. Crossref, Medline, Google Scholar
13 Ferreiros J, Mendez R, Jorquera M, et al. Using gadolinium-enhanced three-dimensional MR angiography to assess arterial inflow stenosis after kidney transplantation. AJR Am J Roentgenol 1999; 172:751-757. Crossref, Medline, Google Scholar
14 Loubeyre P, Abidi H, Cahen R, Tran Minh VA. Transplanted renal artery: detection of stenosis with color Doppler US. Radiology 1997; 203:661-665. Link, Google Scholar
15 Morris PJ, Yadav RV, Kincaid-Smith P, et al. Renal artery stenosis in renal transplantation. Med J Aust 1971; 1:1255-1257. Crossref, Medline, Google Scholar
16 Greenstein SM, Verstandig A, McLean GK, et al. Percutaneous transluminal angioplasty: the procedure of choice in the hypertensive renal allograft recipient with renal artery stenosis. Transplantation 1987; 43:29-32. Crossref, Medline, Google Scholar
17 Benoit G, Hiesse C, Icard P, et al. Treatment of renal artery stenosis after renal transplantation. Transplant Proc 1987; 19:3600-3601. Medline, Google Scholar
18 Grossman RA, Dafoe DC, Shoenfeld RB, et al. Percutaneous transluminal angioplasty treatment of renal transplant artery stenosis. Transplantation 1982; 34:339-343. Crossref, Medline, Google Scholar
19 Munda R, Alexander JW, Miller S, First MR, Fidler JP. Renal allograft artery stenosis. Am J Surg 1977; 134:400-403. Crossref, Medline, Google Scholar
20 Rengel M, Gomes-Da-Silva G, Inchaustegui L, et al. Renal artery stenosis after kidney transplantation: diagnostic and therapeutic approach. Kidney Int Suppl 1998; 68:S99-S106. Medline, Google Scholar
21 Mammen NI, Chacko N, Ganesh G, Jacob CK, Shastry JCM, Pandey AP. Aspects of hypertension in renal allograft recipients: a study of 1000 live renal transplants. Br J Urol 1993; 71:256-258. Crossref, Medline, Google Scholar
22 Roberts JP, Ascher NL, Fryd DS, et al. Transplant renal artery stenosis. Transplantation 1989; 48:580-583. Medline, Google Scholar
23 Sankari BR, Geisinger M, Zelch M, Brouhard B, Cunningham R, Novick AC. Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control. J Urol 1996; 155:1860-1864. Crossref, Medline, Google Scholar
24 Fauchald P, Vatne K, Paulsen D, et al. Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis. Nephrol Dial Transplant 1992; 7:256-259. Crossref, Medline, Google Scholar
25 Benoit G, Moukarzel M, Hiesse C, Verdelli G, Charpentier B, Fries D. Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty. Transplant Int 1990; 3:137-140. Crossref, Medline, Google Scholar
26 O’Connell TX, Mowbray JF. Arterial intimal thickening produced by alloantibody and xenoantibody. Transplantation 1973; 15:262-263. Crossref, Medline, Google Scholar
27 Macia M, Paez A, Tornero F, De Oleo P, Hidalgo L, Barrientos A. Post-transplant renal artery stenosis: a possible immunological phenomenon. J Urol 1991; 145:251-252. Crossref, Medline, Google Scholar
28 Merkus JW, Huysmans FT, Hoitsma AJ, Buskens FG, Skotnicki SH, Koene RA. Renal allograft artery stenosis: results of medical treatment and intervention. Transpl Int 1993; 6:111-115. Crossref, Medline, Google Scholar
29 Pouria S, State OI, Wong W, Hendry BM. CMV infection is associated with transplant renal artery stenosis. QJM 1998; 91:185-189. Crossref, Medline, Google Scholar
30 Zhou YF, Leon MB, Waclawiw MA, et al. Association between prior cytomegalovirus infection and the risk of restenosis after coronary atherectomy. N Engl J Med 1996; 335:624-630. Crossref, Medline, Google Scholar
31 Speir E, Modali R, Huang ES, et al. Potential role of human cytomegalovirus and p53 interaction in coronary restenosis. Science 1994; 265:391-394. Crossref, Medline, Google Scholar
32 Humar A, Uknis M, Papalois V, Gillingham K, Matas A. Is there an association between cytomegalovirus and renal artery stenosis in kidney transplant recipients? (abstr). Transplantation 2000; 69:S386. Crossref, Google Scholar
33 Spinosa DJ, Matsumoto AH, Angle JF, Hagspiel KD, McGraw JK, Ayers C. Renal insufficiency: usefulness of gadodiamide-enhanced renal angiography to supplement CO₂-enhanced renal angiography for diagnosis and percutaneous treatment. Radiology 1999; 210:663-672. Link, Google Scholar

Article History

Published in print: June 2001

Vol. 219, No. 3

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