title: Restoration of renal allograft function via reduced-contrast percutaneous revascularization of transplant renal artery stenosis.
abstract: Transplant renal artery stenosis (TRAS), the most common vascular complication of kidney transplantation, can lead to heart failure, uncontrolled hypertension, and irreversible dysfunction of the transplanted kidney. Percutaneous revascularization can improve outcomes in well-selected patients with symptomatic TRAS, but the intervention itself poses risk to the transplanted kidney because of the quantities of nephrotoxic contrast solution that often are used. We report the case of a patient with TRAS who, 5 months after undergoing a kidney transplant, developed allograft dysfunction and heart failure that required hemodialysis. We performed angioplasty and stenting of the TRAS, using intravascular ultrasonography and fluoroscopy as our primary imaging methods. To minimize further damage to a potentially viable kidney, the volume of intravascular contrast medium used was trivial (a total of 9 cc). Revascularization of the patient's TRAS restored his renal function: within 4 weeks of the procedure, he no longer needed hemodialysis, and his heart failure symptoms had resolved. This case emphasizes the value of early definitive treatment of TRAS and the usefulness of intravascular ultrasonography to minimize the amount of contrast medium used in endovascular procedures.
authors: Phillip A
authors: PA
authors: Erwin
authors: Sachin S
authors: SS
authors: Goel
authors: Surafel
authors: S
authors: Gebreselassie
authors: Mehdi H
authors: MH
authors: Shishehbor
mesh_terms: D000368:Aged; D064591:Allografts; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D018618:Echocardiography, Doppler, Color; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D015641:Radiography, Interventional / Q000009:adverse effects; D020127:Recovery of Function; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media
keywords: Acute kidney injury; contrast media/adverse effects; kidney transplantation; kidney/blood supply; postoperative complications; renal artery obstruction/etiology/therapy; renal artery/ultrasonography; stents; ultrasonography, Doppler