5 Years Experience With Drug Eluting and Bare Metal Stents as Primary Intervention in Transplant Renal Artery Stenosis

Abstract

BackgroundTransplant renal artery stenosis (TRAS) is a common vascular complication after kidney transplantation and is associated with refractory hypertension, volume overload, and graft injury or loss. This article describes 5-year outcomes of endovascular intervention for TRAS with bare metal and drug eluting stents (DES).MethodsWe investigated, as a prospective cohort study, patient and graft outcomes after the targeted use of DES for vessel diameter less than 5 mm and bare metal stents (BMS) for vessel diameter greater than 5 mm as the primary management for TRAS.ResultsFrom March 2008 to November 2014, 57 patients were stented for hemodynamically significant TRAS; 29 received DES, 26 received BMS, and 2 patients received both stent types. They were followed up for a mean of 35.1 ± 22.8 months; a subset of these patients who all received DES were followed up for 61.7 ± 17.5 months. Mean serum creatinine declined from 2.87 ± 1.5 mg/dL at the time of intervention to 1.98 ± 0.76 mg/dL (P < 0.001) at one month follow-up and was 1.96 ±0.92 mg/dL (P < 0.001) at 35.1 ± 22.8 months. Mean systolic blood pressure declined from 159.05 ± 19.68 mm Hg at time of intervention to 135.65 ± 15.10 mm Hg (P < 0.001) at most recent visit. Clinically driven restenosis requiring repeat revascularization occurred in 15.7% of patients.ConclusionsPrimary stenting with DES and BMS is both successful in the initial treatment of TRAS and also produced an immediate and long-term reduction in serum creatinine and systolic blood pressure.

Standardized Duplex Ultrasound-Based Protocol for Early Diagnosis of Transplant Renal Artery Stenosis: Results of a Single-Institution Retrospective Cohort Study

“…Regarding the functional outcomes after endovascular intervention, our study failed to show a statistically significant improvement in graft renal function after the procedure, as described by previous series [ 17 , 20 , 21 ]. This finding might have different explanations.…”

“…Both the DU criteria for suspicion of TRAS and the specific RCs and PSs used in our protocol were adapted from available definitions in the literature and defined according to our personal experience. However, as shown in a recent systematic review of the literature, there is wide heterogeneity regarding the definitions of TRAS diagnostic criteria, the triggers for interventions, the reporting of treatment outcomes, and types of follow-up schedules [ 4 , 21 , 22 ]. As such, we designed a follow-up protocol that could capture the different risk of TRAS in the single KT patient and adjust the intensity and invasiveness of treatment accordingly.…”

Short-Term Outcomes Using a Drug-Coated Balloon for Transplant Renal Artery Stenosis

“…Transplant renal artery stenosis (TRAS), which is evidenced by refractory hypertension and graft dysfunction, has become an increasingly recognized cause of poor long-term patient and allograft survival [ 1 ]. It is reported that the incidence of TRAS ranges from 6% to 23%, depending on the diagnostic criteria, which shows wide variability among reports [ 2 ]. The commonly accepted definition of hemodynamically significant TRAS is arterial lumen stenosis greater than 50% and/or a peak systolic velocity (PSV) exceeding 200 cm/s as measured by ultrasound, computed tomography angiography (CTA), and digital subtraction angiography (DSA) [ 1 – 3 ].…”

Endovascular management of transplant renal artery stenosis: A single‐center retrospective study

“…A greater than 50% narrowing in the renal artery intraluminal diameter or a greater than 15 mmHg pressure drop crossing the stenotic segment is considered to be TRAS . The color Doppler ultrasonography (CDU) standard for the diagnosis of TRAS is peak systolic velocity (PSV) of >2 m/s or a prestenotic segment flow velocity to poststenotic–prestenotic segment ratio of >2:1 …”

“…15 The color Doppler ultrasonography (CDU) standard for the diagnosis of TRAS is peak systolic velocity (PSV) of >2 m/s or a prestenotic segment flow velocity to poststenotic-prestenotic segment ratio of >2:1. 16,17 There are several causes for TRAS, some of which are controversial. Stenosis of anastomotic stoma might be caused by trauma to the donor or recipient vessels during kidney harvesting and transplantation.…”