Minimally invasive salvage therapy for transplanted renal allografts.
OBJECTIVE
To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts.


METHODS
Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed.


RESULTS
All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n = 4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n = 1), stenting for renal vein kinking (n = 2), and percutaneous nephrostomy (PCN) for UO (n = 7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0 ± 3.6 to 2.6 ± 2.1 mg/dL (p < 0.001), as well as patients' clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p < 0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts.


CONCLUSIONS
Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Xing-Long
XL
Liu
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Qing-Quan
QQ
Zu
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Bin
B
Wang
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Chun-Gao
CG
Zhou
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Lin-Bo
LB
Zhao
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Jin-Guo
JG
Xia
b Urology Surgery , The First Affiliated Hospital of Nanjing Medical University , Nanjing , P.R. China.
Min
M
Gu
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Hai-Bin
HB
Shi
a Radiology Department , The First Afflicted Hospital of Nanjing Medical University , Nanjing , P.R. China and.
Sheng
S
Liu
D000293:Adolescent; D000328:Adult; D017541:Aneurysm, False / Q000601:surgery*; D000800:Angioplasty, Balloon; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods; D011183:Postoperative Complications; D012078:Renal Artery Obstruction / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015607:Stents; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D003404:Creatinine
Interventional therapy; transplant renal artery pseudoaneurysms; transplant renal artery stenosis; transplant renal venous kinking; transplanted renal allograft