Efficacy and Safety of Palmaz Stent Implantation in the Treatment of Renal Artery Stenosis in Renal Transplantation

Salvadori, Maurizio; Maria, L. Di; Rosati, Alberto; Larti, A.; Piperno, R.; Becherelli, P; Bandini, S.; Biagini, Maria Rosa; Filocamo, Maria Teresa; Bergesio, Franco; Bertoni, E.

doi:10.1016/j.transproceed.2004.12.229

Cited by 26 publications

(17 citation statements)

References 7 publications

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“…Zupunski et al recently reported no significant deterioration in renal function or BP in a cohort of 34 patients with TRAS followed for three yr when compared with age-and sexmatched controls with no TRAS (3,13). Salvadori et al (14) reported stable renal function and BP at three yr in 26 patients affected by TRAS and treated by PTA and the insertion of an endovascular stent. Audard et al (15) reported significantly worse transplant survival in 29 patients undergoing angioplasty ± endoluminal stent for TRAS compared with controls without TRAS; the poor outcome was at least partly attributable to the immediate loss of three transplants as a direct result of the intervention.…”

Section: Discussionmentioning

confidence: 98%

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Long‐term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention

Geddes

McManus

Koteeswaran

et al. 2008

Clinical Transplantation

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The natural history and optimal treatment of transplant renal artery stenosis (TRAS) is poorly defined. Few studies reported long-term clinical outcomes. A single centre analysis of 43 patients diagnosed with TRAS 1990-2003 was performed. Twenty-seven had percutaneous intervention (including 10 patients who had >1 intervention) and 16 were managed conservatively at the discretion of the attending clinicians. Transplant function was assessed by slope of estimated glomerular filtration rate (eGFR) over five yr of follow-up. Patients in the intervention group had lower mean eGFR (36.3 mL/min/1.73 m(2) vs. 46.3 mL/min/1.73 m(2); p = 0.07) at baseline. Five transplants in the intervention group failed (including two as a direct result of intervention) and one in the conservative group failed. There was no significant difference in the rate of deterioration in renal function (mean slope of eGFR minus 0.8 mL/min/yr and minus 1.0 mL/min/yr in the intervention and conservative groups, respectively; p = 0.79). There was no significant difference in blood pressure or number of anti-hypertensive agents between the groups at any time point. Baseline Doppler ultrasound indices showed no significant correlation with slope of eGFR in either group. Our data demonstrate that selected patients with TRAS can be managed without intervention and that this approach is associated with good long-term outcome. Selection of appropriate patients for intervention remains difficult and larger randomized studies are required.

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Section: Discussionmentioning

confidence: 98%

“…Salvadori et al. (14) reported stable renal function and BP at three yr in 26 patients affected by TRAS and treated by PTA and the insertion of an endovascular stent. Audard et al.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention

Geddes

McManus

Koteeswaran

et al. 2008

Clinical Transplantation

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“…Many recent reports highlight the crucial role of PTA with stenting in limitation of recurrence, with success rate between 90 to 100% [22]. Remarkably, as discussed in a study by Salvadori et al [14], the 5-year actuarial survival rate was similar in patients with TRAS treated with PTA and stenting (76.3%) versus patients who had also undergone renal transplantation and had not developed TRAS (72.9%). …”

Section: Safety and Efficacy Of Percutaneous Transluminal Angioplamentioning

confidence: 95%

Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

Leonardou

Gioldasi

Pappas

2011

Journal of Transplantation

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Transplant renal artery stenosis (TRAS) is a well-known cause of posttransplant hypertension accompanied by possible graft dysfunction and is potentially curable when is diagnosed early. Colour Doppler Ultrasonography (CDU) is the screening procedure of choice in most studies whereas some centers employ Magnetic Resonance Angiography (MRA), if available. Although both CDU and MRA can arouse suspicion of disease in less symptomatic cases, angiographic techniques are essential for confirmation of TRAS. Percutaneous Transluminal Angioplasty (PTA) is a good and widespread therapeutic approach for the treatment of TRAS due to its acceptable complication rate and high technical success rate. The purpose of this paper is to assess the safety and efficacy of PTA in the treatment of TRAS, to compare the long-term outcomes between different reports, and to examine the role of PTA with stenting in inhibiting recurrence of the disease.

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“…Relevant studies in recent 10 years generally favoured an improved hypertension control and creatinine levels (Table 4). 3,[6][7][8][9][10][11][12][13][14] Some also demonstrated improved glomerular filtration rate. These studies, however, generally comprised a small sample size with 8 to 26 patients or interventions.…”

Section: Discussionmentioning

confidence: 99%

“…These studies, however, generally comprised a small sample size with 8 to 26 patients or interventions. 3,[6][7][8][11][12][13][14] One of these studies with a larger sample size of 62 PTA/stenting elicited an early statistically significant (p < 0.05) drop in creatinine and blood pressure only at 1 month after the procedure but not at 6 or 12 months. 10 Another study with 32 stenting procedures and long follow-up of a mean of 85.2 months, however, lacked statistical correlation and support.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Endovascular Intervention in Transplant Renal Artery Stenosis: Long-term Outcome in the Chinese Population

Lui¹,

Lee²,

Tam³

et al. 2014

Hong Kong J Radiol

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Objective. To assess the technical success and long-term outcome in Chinese patients with transplant renal artery stenosis (TRAS) after percutaneous transluminal angioplasty (PTA), with or without stenting. Methods. A retrospective review of 44 consecutive PTA (with or without stenting) in 35 patients with TRAS from September 2003 to January 2012 in two regional hospitals of the New Territories East Cluster, Hong Kong was conducted. Technical success, complications, serum creatinine level, arterial blood pressure, and number of antihypertensive medications taken before and after intervention were assessed and compared. Graft survival was estimated using Kaplan-Meier method. Result. Of 44 interventions (17 PTA and 27 PTA with stenting) performed, 35 were primary interventions and the remaining 9 were secondary for re-stenosis. Overall technical success rate was 95.5% (PTA: 88.2%; PTA with stenting: 100%). No major complication or graft loss during intervention was observed. There were four minor complications including a self-limiting dissection in external iliac artery and three puncture site haematomas. There was no significant difference in restenosis rate between the PTA (25.0%) and PTA with stenting (26.1%) groups (p > 0.05). There was a persistent improvement in graft dysfunction and hypertensive control in the short and intermediate term, with satisfactory clinical success in patients presenting with graft dysfunction (100%) and hypertension (94%). Long-term clinical success in hypertensive control was relatively sustained (84.6%) while that in creatinine level it was only partially sustained (68.5%) with a mean follow-up of 70.3 (standard deviation, 32.9) months. Estimated allograft survival after all interventions was 100% at 1 year and 97% at 5 years. Conclusion. Treatment of haemodynamically significant TRAS with percutaneous endovascular intervention is a safe procedure with high technical success, showing beneficial effects in improving allograft function and blood pressure in the short and intermediate term, as well as good long-term graft survival.

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Efficacy and Safety of Palmaz Stent Implantation in the Treatment of Renal Artery Stenosis in Renal Transplantation

Cited by 26 publications

References 7 publications

Long‐term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention

Long‐term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention

Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

Percutaneous Endovascular Intervention in Transplant Renal Artery Stenosis: Long-term Outcome in the Chinese Population

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