title: Tailoring the endovascular management of transplant renal artery stenosis.
abstract: In this study we analyze the different types of endovascular interventions (EVIs) in de novo transplant renal artery stenosis (TRAS) and its anatomical subtypes to examine any variation in recovery of allograft function, blood pressure control, EVI patency and allograft survival with respect to EVI type (DES: drug-eluting stent, BMS: bare-metal stent, PTA: percutaneous transluminal angioplasty). Forty-five patients underwent a total of 50 primary EVIs (DES: 18, BMS: 26, PTA: 6). Patients were stratified according to medical co-morbidities, graft characteristics, biopsy results, clinical presentation and TRAS anatomic subtypes (anastomotic: 26, postanastomotic: 17, bend-kink: 2). There was significant improvement in allograft function and mean arterial blood pressure (MAP) control across all interventions (pre-EVI-creatinine [CR]: 2.8 ± 1.4, post-EVI-Cr: 2.1 ± 0.7, p < 0.001; pre-EVI-MAP: 117 ± 16, post-EVI-MAP: 112 ± 17, p = 0.03) with no significant difference among EVI types. There was no significant difference in allograft survival with respect to EVI type. Patency was significantly higher in EVIs performed with DES and BMS compared to PTA (p = 0.001). In the postanastomotic TRAS subtype, patency rates were significantly higher in DES compared to BMS (p = 0.012) in vessels of comparable reference diameter (≤5 mm).
authors.affiliation: Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: D M
authors.initials: DM
authors.lastname: Biederman
authors.forename: A M
authors.initials: AM
authors.lastname: Fischman
authors.forename: J J
authors.initials: JJ
authors.lastname: Titano
authors.forename: E
authors.initials: E
authors.lastname: Kim
authors.forename: R S
authors.initials: RS
authors.lastname: Patel
authors.forename: F S
authors.initials: FS
authors.lastname: Nowakowski
authors.forename: S
authors.initials: S
authors.lastname: Florman
authors.forename: R A
authors.initials: RA
authors.lastname: Lookstein
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000601:surgery*
keywords: basic (laboratory) research/science; clinical research/practice; endovascular procedures/stenting; kidney (allograft) function/dysfunction; kidney transplantation/nephrology