title: Management of arterial stenosis affecting kidney graft perfusion: a single-centre study in 53 patients.
abstract: We assessed clinical and duplex sonographic (CDS) findings, and outcome in patients with stenosis of the transplant renal artery (TRAS) or the aorto-iliac segment proximal to the graft (Prox-TRAS) treated with dilatation (PTA), stenting (PTAS) and surgery. From 1988 to 2002, of 1189 patients with renal transplantations, 117 underwent angiography. Fifty-three patients with TRAS (n = 37)/Prox-TRAS (n = 16) were found (4.4%). Clinical presentation included deterioration of hypertension (144 +/- 15/84 +/- 9, 157 +/- 22/90 +/- 10 mmHg; p < 0.001), increase of creatinine (1.7 +/- 0.9, 2.5 +/- 1.3 mg/dL; p = 0.01) and renal failure (n = 12). CDS indicated insufficient perfusion and differentiated between TRAS and Prox-TRAS. From renal transplantation (RTX) until the detection of stenosis pulsatility indices (PI) decreased from 1.2 +/- 0.46 to 0.98 +/- 0.29; (p = 0.001). Fifty-two patients underwent invasive treatment (21 PTA, 10 PTAS and 21 surgery) after which hypertension and creatinine significantly improved. PI increased. Restenosis occurred in 16 (52%) cases of the interventional (PTA 62% and PTAS 30%) and in 3 (14%) of the surgical group (p = 0.011). Hypertension and graft dysfunction due to perfusion problems are rare. Clinical findings are nonspecific but CDS findings are helpful to select patients for angiography. Invasive treatment leads to clinical improvement. Surgery yields better results than PTA, but additional stenting will probably improve the outcome of angioplasty.
authors.affiliation: Department of Nephrology, Heinrich-Heine-University, Düsseldorf, Germany. voicules@uni-duesseldorf.de
authors.forename: Adina
authors.initials: A
authors.lastname: Voiculescu
authors.forename: Michael
authors.initials: M
authors.lastname: Schmitz
authors.forename: Markus
authors.initials: M
authors.lastname: Hollenbeck
authors.forename: Sabine
authors.initials: S
authors.lastname: Braasch
authors.forename: Bernd
authors.initials: B
authors.lastname: Luther
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
authors.forename: Gregor
authors.initials: G
authors.lastname: Jung
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mödder
authors.forename: Bernd
authors.initials: B
authors.lastname: Grabensee
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D001794:Blood Pressure; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D016030:Kidney Transplantation; D008875:Middle Aged; D011183:Postoperative Complications; D012039:Regional Blood Flow; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D013514:Surgical Procedures, Operative; D014019:Tissue Donors; D019737:Transplants; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex