Incidence of Renal Artery Stenosis in Pediatric en Bloc and Adult Single Kidney Transplants

Update on En Bloc Renal Transplantation in Pediatric Recipients

“…While early reports of increased vascular complications with en bloc transplantation were discouraging [14][15][16][17], recent reports have shown more encouraging outcomes [4,[18][19][20], further confirmed by our study findings. This is likely due to increased experience and improvements in surgical techniques over time, which should help further reduce the skepticism in using young donor kidneys for transplantation.…”

Expanding the Organ Donor Pool: Using En Bloc Kidneys in Pediatric Recipients

“…While early reports of increased vascular complications with en bloc transplantation were discouraging [27][28][29][30], recent reports have shown more encouraging outcomes [5,11,26,31]. This is likely due to increased experience and improvements in surgical techniques over time, which should help further reduce the skepticism in using young donors for transplantation.…”

Transplant Renal Artery Stenosis

“…Twenty percent of pediatric enbloc and 7% of adult transplants developed TRAS in a study from Spain but the authors found no association between ACR and TRAS in their cohort of 367 pediatric enbloc and adult single kidney transplants over a 13-year period. Interestingly, they found nearly 46% of TRAS lesions proximal to the anastomosis resulting from recipient atherosclerosis [16]. The hypothesis that immune mediated intimal injury was the major factor in the development of TRAS [7] has never been proven and there is no strong definitive evidence that acute rejection causes TRAS.…”

“…These are patients who should be examined for a bruit because of proximal stenoses in the common iliac artery or the aorta. In a Spanish study, Marques et al found 46% of stenoses were caused by recipient atherosclerosis that caused symptoms of TRAS and these stenotic lesions were proximal to the anastomoses [16]. These lesions can limit arterial flow to the allograft and behave like TRAS (pseudo TRAS) and may simultaneously also have signs and symptoms of lower limb ischemia [17,18].…”