title: Endovascular management of transplant renal artery stenosis.
abstract: OBJECTIVE
  Most clinicians regard angioplasty with or without stent placement to be the treatment of choice for transplant renal artery stenosis (TRAS). However, published results regarding its effectiveness are heterogeneous. The aim of this study was to assess the safety and efficiency of TRAS endovascular therapy.
  
  
  METHODS
  All cases of TRAS admitted for treatment in our unit from January 2009 to December 2012 were reviewed retrospectively. The primary end point was the stenosis-free primary transplant renal artery patency. Secondary end points were freedom from reintervention, graft survival, postoperative serum creatinine level, blood pressure evolution, and the number of antihypertensive drugs pre- and postprocedure.
  
  
  RESULTS
  A total of 17 patients (10 men, 7 women) presenting with TRAS were referred to our institution. During the early post-transplantation process (<15 days), 35.2% of patients presented. The median time to presentation was 40 days. The predominant presentation was graft function alteration (82.3%). Percutaneous balloon angioplasty was performed in five patients (29.4%), while stenting was performed in the remaining 12 patients (70.6%). The stenosis-free primary patency rate and freedom from reintervention rate were 76.5% and 88.2%, respectively. The median follow-up was 19.6 months with 88.2% graft survival. There were no mortalities throughout the follow-up period. Serum creatinine levels decreased significantly from 186 μmol/L (range, 148-310 μmol/L) preoperatively to 160 μmol/L (range, 127-236 μmol/L at discharge (P = .0036). The glomerular filtration rates increased from 32.1 mL/min (range, 21.4-45.8 mL/min) to 41.7 mL/min (range, 27.5-52.4 mL/min; P = .004). Systolic and diastolic blood pressure varied from 140 mm Hg (range, 137-157 mm Hg) and 75 mm Hg (range, 70-80 mm Hg), to 135 mm Hg (range, 130-147 mm Hg and 80 mm Hg (range, 73-80 mm Hg), respectively (P = .11 and P = .36). The preoperative number of antihypertensive medications was 2 (range, 1-3) and remained unchanged (P = .33).
  
  
  CONCLUSIONS
  The endovascular management of TRAS is safe and presents a high rate of technical success with low morbidity. Its impact on serum creatinine levels is significant in our experience. However, the blood pressure items do not seem to improve postoperatively.
authors.affiliation: Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France. Electronic address: drtouma@yahoo.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Touma
authors.affiliation: Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Costanzo
authors.affiliation: Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Boura
authors.affiliation: Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Faris
authors.initials: F
authors.lastname: Alomran
authors.affiliation: Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Combes
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000209:etiology / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D003404:Creatinine