Incidence and Risk Factors of Transplant Renal Artery Stenosis in Living Unrelated Donor Renal Transplantation

Kamali, Koorosh; Abbasi, Mohammad Amin; Behzadi, Ashkan Heshmatzade; Mortazavi, Ahmad; Bastani, Bahar

doi:10.1111/j.1755-6686.2010.00188.x

Cited by 26 publications

(26 citation statements)

References 11 publications

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“…7,9 A considerable portion of our cohort (26.3%) had DGF (dialysis in first week after transplant), higher than our center's overall DGF rate of 17%, 16 which is close to the national reported incidence of DGF, approximately 15% for SCD and approximately 35% for ECD. 17 The higher proportion in our TRAS patients is explained by their mean cold ischemic time longer than 25 hours and 47% of the donor kidneys being ECD.…”

Section: Discussionsupporting

confidence: 58%

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

Estrada

Musani

Darras

et al. 2017

Transplantation Direct

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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.

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Section: Discussionsupporting

confidence: 58%

“…4 Implicated risk factors include atherosclerosis, Cytomegalovirus infection, multiple renal arteries, delayed graft function (DGF), and most recently, donor-specific antibodies. 5-9 …”

mentioning

confidence: 99%

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

Estrada

Musani

Darras

et al. 2017

Transplantation Direct

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“…CMV seropositivity was also linked to restenosis after coronary angioplasty and atherectomy (116). Similarly, in renal transplantation, CMV infection was an independent risk factor in a multivariate analysis of arterial stenosis (117)(118)(119). Such clinical studies are often confounded by difficulties in interpreting serologic data, notably after transplantation; by often unknown timing of CMV infections; and by variability in prophylactic strategies.…”

Section: Nonimmune Pathways In Cmv-associated Allograft Injurymentioning

confidence: 99%

The Cell Biology of Cytomegalovirus: Implications for Transplantation

Kaminski

Fishman

2016

American Journal of Transplantation

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Interpretation of clinical data regarding the impact of cytomegalovirus (CMV) infection on allograft function is complicated by the diversity of viral strains and substantial variability of cellular receptors and viral gene expression in different tissues. Variation also exists in nonspecific (monocytes and dendritic cells) and specific (NK cells, antibodies) responses that augment T cell antiviral activities. Innate immune signaling pathways and expanded pools of memory NK cells and cd T cells also serve to amplify host responses to infection. The clinical impact of specific memory T cell anti-CMV responses that cross-react with graft antigens and alloantigens is uncertain but appears to contribute to graft injury and to the abrogation of allograft tolerance. These responses are modified by diverse immunosuppressive regimens and by underlying host immune deficits. The impact of CMV infection on the transplant recipient reflects cellular changes and corresponding host responses, the convergence of which has been termed the "indirect effects" of CMV infection. Future studies will clarify interactions between CMV infection and allograft injury and will guide interventions that may enhance clinical outcomes in transplantation.

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“…18 Thus, available evidence points to the important role of age in livingdonor kidney transplant, but clear indications of its significance requires further study.…”

Section: Torki Al Otaibi Et Al/experimental and Clinical Transplantatmentioning

confidence: 99%

“…15 Table 1 summarizes the rates of DGF incidence in living-donor transplants reported in studies from the Middle East. [15][16][17][18][19][20][21] The perceived "low" rate of DGF in living-donor kidney transplant should be seen in the context of the nature of its effect after transplant. Delayed graft function may progress into more severe posttransplant events, resulting in increased morbidity rate, prolonged patient hospitalization, and increased health care costs, eventually playing an important role in both acute and chronic graft rejection.…”

Section: Advantages Of Living-donor Kidney Transplantmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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With an increased incidence of living-donor kidney transplants, in response to increasing unmet needs for renal transplant, a clear understanding of determinants of posttransplant outcomes is essential. The importance of delayed graft function in deceased-donor kidney transplant is now part of conventional medical wisdom, due to the large amount of evidence focused on this aspect. However, the same is not true for living-donor kidney transplant, partly due to lack of evidence on this crucial clinical question and partly due to lack of awareness about this issue. The current review aims to highlight the importance of delayed graft function as a crucial determinant of outcomes in living-donor kidney transplant. An exhaustive search of online medical databases was performed with appropriate search criteria to collect evidence about delayed graft function after living-donor kidney transplant, with a special focus on studies from the Middle East. Data on incidence, impact, risk factors, and possible prevention modalities of delayed graft function in patients undergoing living-donor kidney transplant are presented. A key finding of this review is that contemporary incidence rates reported from the Middle East are comparatively higher than those reported from outside the region. Although in absolute terms the incidence is lower than deceaseddonor kidney transplant, the effects of delayed graft function on graft rejection and graft and patient survival are sufficiently large to warrant the formulation of specific treatment protocols. Key to formulating prevention and treatment strategies is identifying discrete risk factors for delayed graft function. Although this evidence is scant, an overview has been provided. Further studies examining different aspects of delayed graft function incidence after living-donor kidney transplant are urgently needed to address a so far little known clinical question.

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Incidence and Risk Factors of Transplant Renal Artery Stenosis in Living Unrelated Donor Renal Transplantation

Abstract: High recipient age, BMI > 30, hyper trigelyceridaemia, previous transplantation, CMV infection and DGF are shown to be risk factors for TRAS.

Cited by 26 publications

References 11 publications

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

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

The Cell Biology of Cytomegalovirus: Implications for Transplantation

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