The Use of Drug-Eluting Stents in the Management of Transplant Renal Artery Stenosis

Abstract

Transplant renal artery stenosis (TRAS) is a common occurrence following kidney transplantation with an incidence rate ranging from 6% to 23%. A single-center retrospective study was conducted to examine the use of drug-eluting stents (DES) in eligible patients with hemodynamically significant TRAS. Between March 2008 and January 2011, 12 patients were diagnosed with TRAS with reference vessel diameter measuring <5 mm and underwent endovascular intervention (EVI) with DES placement. TRAS was detected within the first year posttransplantation in a majority of these patients (83%) and manifested as hypertension (100%), allograft dysfunction (100%) and edema (58%). Procedural success rate was 100%. Patients were followed for a mean period of 16 ± 10 months. Blood pressure improved from a mean of 156/82 to 138/73 mmHg at the end of the follow-up period. In 11/12 patients, serum creatinine improved from 3.1 ± 1.3 mg/dL to 2.3 ± 0.5 mg/dL at the end of the follow-up period. TRAS of early onset is readily amenable to EVI with stent placement resulting in improvement in blood pressure control and allograft function.

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

“…Previously described complications in the endovascular treatment of TRAS such as dissection, thrombosis or rupture were not seen in our study. Our technical success and complication rates are comparable to prior studies on the use of PTA, BMS and DES in TRAS (18,19).…”

“…Within the TRAS population, data supporting BMS over PTA exists primarily in the form of comparisons across different retrospective studies (7,29). Recent studies also show the use of DES as a feasible and safe EVI option in de novo and secondary TRAS (18,19).…”

“…More recently, drug-eluting stents (DESs) have been reported to be a feasible and safe option in both de novo and restenosis TRAS (18,19). Interest in using DES in the endovascular management of TRAS is derived from numerous prospective studies citing their lower rates of restenosis in the treatment of coronary artery disease (CAD) (20)(21)(22)(23)(24) as well as similarities in vessel diameter of the coronary and renal arteries.…”

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

“…Eleven studies included patients following stenting alone (n = 201) [1,2,6,[14][15][16][17][18][19][20][21]. Twelve studies involved patients receiving either PTA alone or stenting with pre balloon dilatation (n = 407, of which PTA alone = 271, stent following PTA = 89, and PTA and/or stent following PTA not discriminated in a single intervention arm = 47) [3,5,[22][23][24][25][26][27][28][29][30][31].…”

“…The disease is often asymptomatic and unrecognised, and despite being a potentially reversible cause of refractory hypertension and graft dysfunction in kidney transplant recipients, it is associated with poor long term patient and allograft survival [2].…”