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Renal Arterial Stenosis in Renal Allografts: Retrospective Study of Predisposing Factors and Outcome after Percutaneous Transluminal Angioplasty¹

¹ From the Departments of Radiology (N.H.P., T.W., S.R., M.S.J., H.S., J.N., K.P.M., S.O.T.) and Surgery (R.M.J.), Indiana University Medical Center, 550 N University Blvd, Rm 0279, Indianapolis, IN 46202; and Department of Surgery, University of Glasgow, Scotland (R.M.J.). Received June 20, 2000; revision requested August 8; final revision received January 2, 2001; accepted January 22. Address correspondence to N.H.P. (e-mail: nhpatel@iupui.edu).

PURPOSE: To determine the predisposing factors to transplant renal arterial stenosis (TRAS) and assess the outcome of percutaneous transluminal angioplasty (PTA) as the primary treatment.

MATERIALS AND METHODS: Of 831 renal allograft recipients (584 cadaveric, 247 living related) between January 1991 and December 1998, 72 had hypertension and/or renal dysfunction. All 72 underwent arteriography, and their medical charts were retrospectively reviewed.

RESULTS: Prevalence of TRAS was 3.1% (26 of 831). Technical success rate of PTA was 94% (16 of 17), and clinical success rate was 82% (14 of 17). Those with renal dysfunction had a mean pre-PTA creatinine value of 2.6 mg/dL (230 µmol/L) ± 0.5 (SD) versus a 1-week post-PTA value of 1.7 mg/dL (150 µmol/L) ± 0.3 (P < .001). Of those with hypertension, all but one had substantial improvement in mean diastolic blood pressure. At 26.9 months mean follow-up in 16 patients with successful PTA, two stenoses reoccurred, and two grafts were lost to chronic rejection. TRAS was present in 14 of 45 end-to-side anastomoses and 12 of 27 end-to-end anastomoses (P = .31), and TRAS was more prevalent in cadaveric grafts (24 of 584) than in living related grafts (two of 247). In cadaveric grafts, the mean cold ischemia time was 29.0 hours ± 6.9 in those with TRAS (n = 24), as compared with 25.5 hours ± 8.1 in those with no TRAS (n = 39; P = .35). Seven of 17 patients with acute rejection and six of 35 with chronic rejection had TRAS.

CONCLUSION: Primary treatment of TRAS with PTA has good intermediate-term results. TRAS is more prevalent in cadaveric allografts with long cold ischemia time.

Index terms: Kidney, transplantation, 81.4557 • Renal arteries, stenosis or obstruction, 961.7212, 961.7213 • Renal arteries, transluminal angioplasty, 961.1282

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