title: Management of transplant renal artery stenosis and its impact on long-term allograft survival: a single-centre experience.
abstract: BACKGROUND
  Transplant renal artery stenosis (TRAS) is a recognized complication resulting in post-transplant hypertension associated with allograft dysfunction. It is a commonly missed but potentially treatable complication that may present from months to years after transplant surgery. In this retrospective study, we compared management strategies and outcomes of TRAS from 1990 to 2005.
  
  
  METHODS
  Case notes of transplant recipients with TRAS demonstrated by angiography were reviewed. Angiography and was carried out when there was a clinical or Doppler ultrasound suspicion of TRAS. The clinical diagnosis of TRAS was based on uncontrolled refractory/new-onset hypertension and/or unexplained graft dysfunction in the absence of another diagnosis, such as rejection, obstruction or infection. The two-tailed Student t-test was used to analyse the differences between mean arterial pressure, serum creatinine, and estimated glomerular filtration rate before and after the intervention.
  
  
  RESULTS
  Sixty-seven patients with angiogram-confirmed TRAS were included. Forty-four, 9 and 14 patients were managed with primary percutaneous transluminal renal angioplasty (PTRA), surgical intervention and conservative treatment, respectively. Uncontrolled hypertension was the most common presentation noted in 74.62%. Post-anastamotic single stenosis was the commonest occurrence (n = 53). Angioplasty had the highest 1- and 5-year graft survival rate of 91% and 86%, respectively. The worst prognosis was noted in patients treated with secondary PTRA after failed surgery or secondary surgery after failed primary PTRA.
  
  
  CONCLUSIONS
  TRAS is a recognized complication resulting in loss of renal allografts. Early Doppler ultrasound is a good primary diagnostic tool. Early intervention is associated with a good long-term graft function.
authors.affiliation: Department of Transplant Surgery, Manchester Royal Infirmary, UK. abbas.ghazanfar@cmft.nhs.uk
authors.forename: Abbas
authors.initials: A
authors.lastname: Ghazanfar
authors.forename: Afshin
authors.initials: A
authors.lastname: Tavakoli
authors.forename: Titus
authors.initials: T
authors.lastname: Augustine
authors.forename: Ravi
authors.initials: R
authors.lastname: Pararajasingam
authors.forename: Hany
authors.initials: H
authors.lastname: Riad
authors.forename: Nicholas
authors.initials: N
authors.lastname: Chalmers
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000800:Angioplasty, Balloon; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality*; D016030:Kidney Transplantation / Q000401:mortality*; D011183:Postoperative Complications; D012078:Renal Artery Obstruction / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome