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

Abstract

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.

A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis

“…A consensus regarding the management of TRAS remains elusive due to a lack of good quality published data, with some authors advocating intervention with percutaneous transluminal angioplasty (PTA) with or without endovascular stenting [4], whilst others recommend a more conservative approach [5].…”

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

“…There is significant variability in the reported incidence of TRAS (1-25%) likely secondary to institutional variation of screening protocols, thresholds for intervention and baseline patient demographics (1)(2)(3)(4)(5)(6)(7)(8). The management of TRAS is more widely agreed upon with endovascular intervention (EVI) playing a significant role in preserving graft function and prolonging graft survival (1,(9)(10)(11).…”

Incidence, Predictors and Outcomes of Transplant Renal Artery Stenosis after Kidney Transplantation: Analysis of USRDS

“…The long-term graft survival was significantly lower in the TRAS group compared to controls. However, in a study of 43 patients with TRAS (27 transplant recipients had PTA and 16 were managed conservatively), Geddes et al [5] found that there was no significant difference in the rate of deterioration in renal function or in blood pressure or number of antihypertensive agents between the groups at any time point. In their retrospective single-center study, 5 transplants in the intervention group failed (including 2 as a direct result of intervention) and 1 in the conservative group failed.…”