Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control.
OBJECTIVE
We assessed the long-term outcome of different treatment methods for transplant renal artery stenosis.


METHODS
Outcome data for 23 patients with transplant renal artery stenosis treated during a 16-year period were reviewed and analyzed.


RESULTS
There was a higher incidence of renal artery stenosis in cadaveric donor kidneys compared to living donor kidneys (2% versus 0.3%, p < 0.02), and in cadaveric kidneys from pediatric donors less than 5 years old compared to those from adults (13.2% versus 1.3%, p < 0.01). Six patients underwent primary medical treatment for renal artery stenosis, with a successful outcome in 4 (mean followup plus or minus standard error 57 +/- 22 months) and failure in 2. Of the patients 16 were treated with percutaneous transluminal angioplasty, including 12 who were cured or improved with respect to hypertension (followup 44.7 +/- 7.6 months). Five patients underwent surgical revascularization for renal artery stenosis with postoperative improvement of hypertension (followup 18.8 +/- 11.6 months). Overall, 21 of 23 patients (91%) were treated successfully for transplant renal artery stenosis with cure or improvement of associated hypertension. Posttreatment renal function was stable or improved in 18 patients, while renal function deteriorated due to parenchymal disease in 3.


CONCLUSIONS
Most patients with transplant renal artery stenosis can be treated successfully. Percutaneous transluminal angioplasty is the initial interventive treatment of choice for high grade renal artery stenosis. Surgical revascularization is indicated if percutaneous transluminal angioplasty cannot be done or is unsuccessful.
Sankari
B R
BR
Department of Urology, Cleveland Clinic Foundation, Ohio, USA.
Geisinger
M
M
Zelch
M
M
Brouhard
B
B
Cunningham
R
R
Novick
A C
AC
D000328:Adult; D000800:Angioplasty, Balloon; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002102:Cadaver; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D006978:Hypertension, Renovascular / Q000453:epidemiology / Q000628:therapy*; D015994:Incidence; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D012078:Renal Artery Obstruction / Q000453:epidemiology / Q000628:therapy*; D012086:Reoperation; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D000959:Antihypertensive Agents