Analysis Of Mid-term Clinical Efficacy And Its Influencing Factors In Treatment Of Transplant Renal Artery Stenosis With Bare Stent Placement

BackgroundChronic kidney disease(CKD)as a major public health problem has received more and more attention.The treatment of CKD includes primary disease treatment,treatment of various risk factors,and delaying the progression of chronic renal insufficiency and so on,when CKD patients progress to end stage renal disease(ESRD),renal replacement therapy should be performed promptly,including dialysis treatment and kidney transplantation(KT).KT is one of the most effective treatments for ESRD.Transplant renal artery stenosis(TRAS)is one of the common severe vascular complications after KT.In severe cases,the transplanted kidney can be lost.At present,the treatment of TRAS mainly includes conservative medical treatment,interventional therapy,and surgical treatment.Interventional therapy become the main treatment of TRAS with its minimally invasive,rapid recovery and significant effect,including simple balloon dilation,stenting and so on.Reported in the literature of TRAS interventional treatment of clinical efficacy there is a big difference,the impact of stent placement of TRAS clinical efficacy of factors is not yet clear.PurposeTo analyze the difference of clinically relevant indexes before and after the treatment of TRAS with bare stent placement,to evaluate the mid-term clinical efficacy and safety of bare stent in the treatment of TRAS,and to explore the influencing factors of mid-term clinical efficacy of TRAS treated with bare stent.Material and MethodsClinical data of 40 patients who suffered from TRAS and treated with bare stent placement in the department of interventional radiology of South Medical University Nan-fang Hospital from January 2012 to January 2016 were retrospectively analyzed,including 27 males and 13 females,aged 21～63 years,the average(43.7 ± 10.0)years old.The stenosis is divided into four types according to the transplant renal artery angiography:type Ⅰ(anastomotic stenosis),type Ⅱ(main stenosis),type Ⅲ(branch stenosis),type Ⅳ(host artery stenosis).All patients underwent TRAS bare-stent implantation and took anticoagulant and/or antiplatelet drugs for at least 6 months postoperative.Follow-up was performed in the first,third,sixth month and every six months thereafter postoperative.Data such as systolic blood pressure,diastolic blood pressure,serum creatinine,eGFR,urine output before and after the treatment of TRAS with bare stent placement were recorded.The general data of patients with TRAS,primary renal disease,the source of donor,the type of vascular anastomosis,the number of renal artery,the type of TRAS,the type of stent,stenosis length,stenosis degree,anastomosis vascular angle and other relevant data are also recorded.Clinical efficacy evaluation criteria are divided into complete remission,partial remission and no remission,and clinical success is defined as complete remission.SPSS 20.0 was used for statistical analysis.The paired t-test was used to analyze the difference in the mean between the measurement data.The comparison between count data was compared with the chi-square test,P<0.05 was considered statistically significant.Dim the clinical efficacy after the treatment of TRAS with bare stent placement as the dependent variable,P<0.05 in the univariate analysis was used as the standard for multivariate Logistic regression analysis.ResultsThe technical success rate was 100%in the treatment of TRAS with bare stent placement for 40 cases.The stent patency rate was 97.5%,97.5%,100%at 3,6 months and 2 years postoperative.The mid-term clinical success rate after the treatment of TRAS with bare stent placement was 65%.Preoperative urine volume of all patients is significantly different from 2 years after the treatment of TRAS with bare stent placement(1773.00 ± 353.19 vs.2060.50 ± 354.61,t = 7.013,P<0.01).The systolic blood pressure,diastolic blood pressure,and serum creatinine levels decreased at different degrees postoperative compared with preoperative ones,and decreased from 150.68 ± 17.19,86.23 ± 12.08,256.43 ± 201.29 to 130.48 ± 12.42,79.08 ± 7.09,144.80 ± 89.83 respectively,the difference is statistically significant(P<0.01).The eGFR of 2 years after bare stent implantation for TRAS was(71.31 ±29.05),which is significantly different from preoperative eGFR(39.06± 17.52)(P<0.01).The gender(χ2= 2.105,P>0.05),the history of hypertension(χ2= 0.733,P>0.05),the kind of dialysis(P>0.05),the number of donor renal artery(χ2= 0.158,P>0.05),the source of donor(χ2 = 1.494,P>0.05),kidney primary disease(χ2 ＝1.459,P>0.05)and immune rejection after kidney transplantation(P>0.05)have no statistically significant between the clinical success and clinical failure group,but the mid-term clinical success rate after bare-stent implantation in TRAS has statistically significant between age>50 years old group and age<50 years old group(χ2 =6.260,P<0.05).The mid-term clinical success rate of bare stent implantation in the treatment of TRAS has no statistically significant in the groups which divided by renal artery stenosis length(P>0.05),the rate of renal artery stenosis(χ2 = 3.511,P>0.05),the types of TRAS(χ2 = 4.126,P>0.05)and the types of intraoperative stenting(χ2 = 5.692,P>0.05),but there is statistically significant difference in mid-term clinical success rate between anastomotic vascular angle<120°group and anastomotic vascular angle≥ 120° group(χ2=6.884,P<0.05).The multivariate analysis suggests that age ≥ 50 years old(OR = 5.600)and anastomotic vascular angle ≥ 120°(OR = 4.988)is possible risk factor for mid-term clinical failure after bare stent treatment for TRAS.Correlation analysis show that there is a positive and weak correlation between the incidence of restenosis after bare stent implantation in the treatment of TRAS and low-density lipoprotein cholesterol(LDL-C)preoperative(r = 0.391,P<0.05).Conclusions1.The treatment of bare stenting for TRAS is safe and effective.2.Age>50 years old(OR = 5.600)and anastomotic vascular angle>120°(OR＝4.988)are possible risk factors for mid-term clinical failure after the treatment of TRAS with bare stent placement.3.There is a positive and weak correlation between the incidence of restenosis after the treatment of TRAS with bare stent placement and low-density lipoprotein cholesterol(LDL-C)preoperative.