Percutaneous renal artery embolisation of non-functioning renal allografts with clinical intolerance

Abstract

The aim of the study was to evaluate the efficacy and safety of percutaneous renal artery embolisation of non-functioning renal allografts in patients with graft intolerance syndrome (GIS). Transcatheter artery embolisation was performed in 30 kidney transplant recipients with GIS. The duration of graft function had been 60+/-45 months. Infectious disease was ruled out in all patients. Embolisation consisted of the injection of polyvinyl alcohol microspheres followed by the insertion of a stainless steel coil in the renal artery branches. Symptoms of GIS included: fever-graft pain (44%, n=13), fever-hematuria-pain (20%, n=6), fever-hematuria (13%, n=4) and fever alone (23%, n=7). Latency time between graft failure and embolisation was 184+/-227 (17-1181) days. Embolisation was clinically successful with the prolonged disappearance of GIS in 24 patients (80%). Six patients showed initial clinical improvement, but GIS reappeared at 40+/-18 days, and graft nephrectomy was required. There were no major complications associated with embolisation and no deaths. Perirenal collateral supply was a risk factor for the reappearance of GIS. Renal vascular embolisation is a simple, safe and effective technique for treating renal allograft intolerance syndrome and could be a feasible alternative for the first-line treatment.

Renal graft intolerance syndrome in late graft failure patients: efficacy and safety of embolization as first-line treatment compared to surgical removal

“…Apart from the expected self‐limited postembolization syndrome (fever and/or local pain for 2–3 days) observed in many patients, a mild puncture site haematoma, although not frequently observed, is the main complication of this procedure. Similar results were reported in previous studies . Other very rare previously reported complications include emphysematous pyelonephritis, pseudoaneurysm, and graft and groin abscesses .…”

“…Regarding the efficacy of percutaneous embolization, our study shows that complete resolution of graft intolerance syndrome was observed in 27 of 32 patients (84.37%) which is comparable to previous studies . Several relevant points need to be discussed here.…”

“…. Although its efficacy in the resolution of the graft intolerance syndrome has been demonstrated to be between 60% and 100% and its morbidity to be very low , graft embolization has not gained widespread acceptance and there is no clear consensus as to its indications or results compared to surgery.…”

Renal transplant nephrectomy in children: Can an aggressive approach be recommended?

“…Recently, a new less invasive technique of renal artery embolization has been utilized for treating renal allograft intolerance syndrome and appears to be safe and effective in 80 % of adult patients with graft failure (15). The use of this technique awaits utilization in children.…”

Renal Artery Embolization for Neoplastic Conditions

“…7,8 Similarly, functional exclusion with RAE can be used to treat nephrotic syndrome and cases of graft intolerance syndrome associated with failed renal transplants. [9][10][11] Less frequent indications include arteriovenous malformations, renal artery aneurysms, and autosomal dominant polycystic kidney disease. Benign and malignant neoplasms together comprise the most common indications for RAE, which will be reviewed in detail in this article.…”