Angioplasty vs stent in the treatment of transplant renal artery stenosis

Chen, Ling Xin; Mattos, Angelo de; Bang, Heejung; Vu, Catherine; Gandhi, Mehul M; Alnimri, Muna A; Gallay, Brian J.; Fananapazir, Ghaneh

doi:10.1111/ctr.13217

Cited by 12 publications

(7 citation statements)

References 18 publications

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“…Another study reported a restenosis rate of 28% in patients treated with angioplasty alone and of 8% in patients treated with stenting. 29 The median follow-up period was longer in our study compared to other published studies, but the reintervention rate was concordant with the current literature. 2…”

Section: Discussionsupporting

confidence: 92%

Endovascular Treatment of Transplant Renal Artery Stenosis: Evaluation of Postoperative Outcomes and Risk Factors for Recurrence

Roustan

Lareyre²,

Bentellis³

et al. 2018

Angiology

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Angioplasty with or without stenting has become a well-established procedure to treat transplant renal artery stenosis (TRAS). We evaluated our experience on postoperative outcomes following the intervention and identified potential predictive factors of TRAS recurrence. Consecutive patients who underwent endovascular treatment of TRAS were retrospectively reviewed. The study end points were the technical success, 30-day postoperative complications, and the estimated glomerular filtration rate (eGFR). Thirty-two patients underwent endovascular treatment for TRAS. The technical success rate was 96.6%. Complications were observed for 7 (21.9%) patients: 4 had a dissection, 2 a pseudoaneurysm, and 1 (3.1%) patient developed an acute pulmonary edema. The mean eGFR significantly increased at 7 days, 3 months, and 6 months postintervention (43.1, 44.9, and 44.3 vs 33.9 mL/min/1.73 m preoperatively, P < .05). The TRAS recurrence was observed in 7 (21.9%) patients. These patients had significantly higher preoperative peak systolic velocity and systolic rise time (5 vs 4 m/s, P = .0383 and 103 vs 80 milliseconds, P = .0148, respectively). Endovascular treatment of TRAS is associated with high technical success and significant improvement in renal function. Further studies are required to confirm predictive factors of TRAS recurrence following endovascular treatment.

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Section: Discussionsupporting

confidence: 92%

Endovascular Treatment of Transplant Renal Artery Stenosis: Evaluation of Postoperative Outcomes and Risk Factors for Recurrence

Roustan

Lareyre²,

Bentellis³

et al. 2018

Angiology

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“…Renal artery stenosis after transplantation has been reported to be 1% to 23% in the literature, although the true incidence may vary depending on the routine screening and the method of diagnosis of the stenosis. [23,24] Graft dysfunction and hypertension are the most common indications for intervention. Treatment options include medical management, percutaneous transluminal angioplasty, stent placement and surgical reconstruction.…”

Section: Discussionmentioning

confidence: 99%

An updated analysis of the surgical and urological complications of 789 living related donor kidney transplantations: Experience of a single center

Oktar

Koçak

Tefik

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: This study aims to review retrospectively the surgical and urological complications encountered in 789 cases of living-related donor kidney transplantations (LRDKTs). METHODS:In this study, the clinical records of 789 LRDKTs, which were performed between 1983 and 2017, were reviewed retrospectively concerning surgical and urological complications. RESULTS:Overall, urological and surgical complications were encountered in 87 (11.02%) of the cases. Of the 789 patients, urological complications were detected in 44 of them (5.6%), including 8 urinary fistula (with 1 distal ureteral necrosis), 10 ureteric stenosis, 1 renal calculus, 9 symptomatic vesicoureteral reflux and 16 lymphoceles requiring intervention. As surgical complications (n=43), vascular complications were encountered in 8 cases; there were 5 cases with renal artery stenosis and 3 with renal vein thrombus. Wound infection was detected in 14 patients. Eighteen patients underwent surgical explorations due to perinephric hematoma during the early postoperative period. Renal allograft rupture due to accelerated rejection was developed in 2 cases. A lower segmental arterial injury occurred in 1 patient during the operation. CONCLUSION:In our series, urological and surgical complications were detected in 11.02% of the recipients. Although complications still encountered, early identification of these complications with proper management strategies significantly decreases the risk of graft loss.

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“…Only 35 studies provided enough data for meta-analysis. An overall summary of the included studies, size, and evidence grading can be found in Supplemental Table S1 2,4,7,12,27-77 . We propose a diagnostic and therapeutic algorithm that reflects the findings, which is displayed in Figure 2 on the basis of the frequency of reporting cutoff parameters.…”

Section: Resultsmentioning

confidence: 99%

“…Current studies that compared both techniques report increased baseline luminal narrowing in patients undergoing stenting, suggesting possible biases in patient selection and susceptibility. Chen et al 64 suggested defaulting to PTA in cases with <70% stenosis, whereas Macchini et al 66 used stenting after suboptimal primary PTA. Biederman 58 , however, has highlighted the benefits of stenting in restenosis rates; this finding is supported by evidence produced by this meta-analysis, showing significantly reduced restenosis when stenting is applied.…”

Section: Discussionmentioning

confidence: 99%

“…Even in studies where baseline differences were identified, stenting offered a greater significant reduction in luminal narrowing. 64 Thus, the currently available limited evidence suggests better outcomes in PTAS and should be considered as the main intervention. Patient evaluation and tailoring remain key, as factors such as proximity to bifurcations and tolerance anticoagulation and/or antiplatelet therapy should be considered as possible contraindications to stenting.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

et al. 2021

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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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Angioplasty vs stent in the treatment of transplant renal artery stenosis

Abstract: Stent placement resulted in fewer cases of restenosis compared with angioplasty alone, although no benefit in terms of serum creatinine, blood pressure, or patient and graft survival was shown.

Cited by 12 publications

References 18 publications

Endovascular Treatment of Transplant Renal Artery Stenosis: Evaluation of Postoperative Outcomes and Risk Factors for Recurrence

Endovascular Treatment of Transplant Renal Artery Stenosis: Evaluation of Postoperative Outcomes and Risk Factors for Recurrence

An updated analysis of the surgical and urological complications of 789 living related donor kidney transplantations: Experience of a single center

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

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