Renovascular hypertension: results in adulthood of renal autotransplantation performed in children

Chavent, Bertrand; Duprey, Ambroise; Lavocat, Marie-Pierre; Fichtner, Christopher G.; Béraud, A M; Albertini, Jean‐Noël; Favre, Jean‐Pierre; Maillard, Nicolas; Barral, Xavier

doi:10.1007/s00467-017-3664-x

Cited by 5 publications

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“…5 So, there is little to be expected from a study reporting clinical data at one year after surgery of which the benefit is to yield a more lasting result than percutaneous angioplasty. Of note, it was somewhat surprising that a higher rate of cure of hypertension was obtained in atherosclerotic renal artery stenosis than in patients with fibromuscular dysplasia (FMD), for which numerous articles have shown a long lasting cure of hypertension, as high as 58%, 6 or 50% in a series of children from Chavent et al 7 with a mean follow up of 15 years.…”

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confidence: 99%

Renal Artery Surgery: The Struggle for Technical Advances and Durable Outcomes

Duprey

Ricco

2019

European Journal of Vascular and Endovascular Surgery

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A large number of recent RCTs have cast an ominous shadow on indications for surgical intervention on renal artery stenosis (RAS).The latest ESC/ESVS 2017 guidelines remind us that medical therapy remains the best option for RAS and that surgery should be considered only in highly selected cases such as symptomatic RAS associated with complex anatomy, failed endovascular procedure, or during open aortic surgery. 1 The main goal of renal artery surgery in patients with RAS is to treat resistant hypertension. In patients with renal artery aneurysm (RAA), renal artery surgery aims to either protect from rupture or to treat concomitant hypertension.In their study, Steuer et al. 2 have clearly highlighted that renal artery surgery is indeed feasible and maintainable. They reported a postoperative mortality rate of 4.3% for atheromatous RAS patients, which is consistent with previous reports from the 1990s. 3,4 However, with a median follow up of 10 years, the results on hypertension have been given at one year only, limiting the value of the report. If after three years, the effect on hypertension has disappeared, the message on the durability of RAS surgery loses some of its interest. As a reminder, with a median follow up of 43 months, CORAL failed to identify any benefit of renal artery intervention compared to best medical treatment. 5 So, there is little to be expected from a study reporting clinical data at one year after surgery of which the benefit is to yield a more lasting result than percutaneous angioplasty. Of note, it was somewhat surprising that a higher rate of cure of hypertension was obtained in atherosclerotic renal artery stenosis than in patients with fibromuscular dysplasia (FMD), for which numerous articles have shown a long lasting cure of hypertension, as high as 58%, 6 or 50% in a series of children from Chavent et al. 7 with a mean follow up of 15 years.Among the most challenging aspects of reporting the results of a retrospective study or a registry is that different pathologies and techniques are amalgamated into a necessarily heterogeneous group. In this report, we do not know which anatomical criteria determine the choice between the different reported techniques. Although it is stated that only one aneurysm was treated by ex vivo repair, it is not known which technique was used. Nor is it known why a hypogastric arterial graft was not the preferred material used in the six RAAs located in the branches of the renal artery?Furthermore, for saccular and short necked RAA, laparoscopic neurosurgical clip placement procedures which reduce surgical aggressiveness have not been discussed in this series. 8 Similarly, in cases of ex vivo repair with renal auto transplantation, not a word on laparoscopy for kidney extraction which has been shown to be an interesting alternative. 9In summary, even though surgery for RAA has improved over the last 10 years, the authors do not report the many specific techniques now routinely used in dedicated centres to improve quality and safety, for example on tab...

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confidence: 99%

Renal Artery Surgery: The Struggle for Technical Advances and Durable Outcomes

Duprey

Ricco

2019

European Journal of Vascular and Endovascular Surgery

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“…In their recently published article entitled BRenovascular hypertension: results in adulthood of renal autotransplantation performed in children^, Chavent et al present good long-term results for renal autotransplantation performed in children [1]. However, we would like to draw attention to the potential complications of this surgery that are not mentioned in this paper.…”

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confidence: 81%

Comments on Chavent et al.: Renovascular hypertension: results in adulthood of renal autotransplantation performed in children

Schiava

Lermusiaux

2017

Pediatr Nephrol

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“…The efficacy of RA in treating hypertension secondary to renovascular disease is favorable but mixed [10,14,17,29,31,32]. A recent systematic review reports that after RA for renal artery aneurysms, only 56% of patients had their hypertension cured or improved [11 ▪ ]; that said, among children undergoing RA for renovascular hypertension with 15-year mean follow-up, the long-term benefits were robust with all 16 patients either cured of hypertension or improved [43].…”

Section: Renovascular Diseasementioning

confidence: 99%

Indications for and results of renal autotransplantation

Han

Johnson

Schulster

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewTo understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. Recent findingsRenal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) --though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists.

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Renovascular hypertension: results in adulthood of renal autotransplantation performed in children

Abstract: This study shows that renal autotransplantation has good and stable long-term results and is an effective conservative strategy for treating renovascular hypertension in children, thus avoiding nephrectomy.

Cited by 5 publications

References 20 publications

Renal Artery Surgery: The Struggle for Technical Advances and Durable Outcomes

Renal Artery Surgery: The Struggle for Technical Advances and Durable Outcomes

Comments on Chavent et al.: Renovascular hypertension: results in adulthood of renal autotransplantation performed in children

Indications for and results of renal autotransplantation

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