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

Abstract

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.

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

“…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.…”

Endovascular treatment for transplant renal artery stenosis

“…Standardized screening protocol using DUS may enable early detection of recurrence following endovascular procedure. [28] There are several drawbacks to this study: this was a retrospective single-center study with a small sample size and the absence of control groups, such as those who had no TRAS or those who had no symptoms or signs of TRAS. Similar to the sample of another study, the dataset was heterogeneous, and the lack of standard methodology and reporting systems are also limitations of this study.…”

“…Also, another study reported that increased PSV could potentially serve as a predictive measure of TRAS recurrence. Standardized screening protocol using DUS may enable early detection of recurrence following endovascular procedure [28] …”