| BackgroundTransplant renal artery stenosis (TRAS) displays an increasing morbidity and renal allograft loss as the development of kidney transplantation (KT). In spite of the continuous progresses in surgical techniques and immunosuppressive agents, multifarious vascular and nonvascular complications occur after KT. The vascular complications occur in approximately 3-15% of renal recipients and may result in allograft loss even mortality. TRAS is one of the most common vascular complications, and it may lead to renal allograft dysfunction and uncontrolled hypertension. Percutaneous transluminal renal angioplasty (PTA) with or without stent implantation as the first-line treatment has proved to be safe and effective. This study is aimed to analyze the clinical features and long-term outcomes of TRASObjective1. To analyze the clinical features of TRAS, so as to provide a theoretical basis for the early diagnosis and treatment of TRAS.2. To evaluate the outcomes of PTA for transplant renal artery stenosis by analysis of the renal function and blood pressure (BP) before and after PTA.Objects and Methods1. From October 2009 to July 2015, a total of 660 patients have received KT at the Second Hospital of Shandong University, of which 22 were confirmed TRAS. Reviewed parameters included data of the transplantation like original renal disease, kidney resource, anastomoses and immunosuppressive agents, stenosis, diagnosis, treatment, serum creatinine levels (Scr) and BP etc.2. Technical success was evaluated immediately after PTA by angiography.3. The short-term outcomes were evaluated by Scr levels and BP 1 month after PTA. Statistical comparisons were done by use of paired sample Students’/-test, and a p value of<0.05 was considered as statistically significant. Doppler ultrasonography (DUS) was used as the screening tool and angiography was the diagnostic method for TRAS. Clinical success was evaluated by allograft function and BP.4. The long-term outcomes were evaluated by Scr levels and BP, which were separately measured at 2,3,6,12,16 months.Results:1. The original renal diseases of the 660 KTs were manily chronic glomerulonephritis, hypertensive nephropathy and toxic nephropathy.22 cases were confirmed TRAS, the overall incidence was 3.3%; the incidence of cadaveric renal transplantation was 3.0% (16/539), the living related renal transplantation was 5.0%(6/121), and there was no significant difference (P>0.05) between them; the incidence of male patients was 3.6% (18/500), female was 2.5%(4/160), and there was no significant difference (,P>0.05) between them; the incidence of end-to-end anastomosis was 3.4%(15/447), end-to-side was 3.3%(7/213), and there was no significant difference (P>0.05) between them. TRAS mainly occurred in 76-173 days after KT. The main clinical presentation was allograft dysfunction and hypertension, only 1 case was hypertension alone. Ultrasonography showed a sensitivity of 100% and a specificity of 95.5%.9.2% (2/22) of the TRAS was pre-anastomotic stenosis,40.9%(9/22) was anastomotic stenosis,45.4%(10/22) was post-anastomotic stenosis,4.5%(1/22) was multiple stenoses.2. PTA was performed on 20 cases, all the stenoses were significantly improved after PTA (85.3%±15.0% vs 10.6%±5.7%,P<0.05). No major complication record. Restenosis was noted in 2 cases, the restenosis incidence was 9.1%.3. The mean Scr level pre-intervention and 1 month post-intervention were 321.6± 8.5 (range,171.3-862.0) μmol/L and 141.3±9.2 (range,74.3-260.8) μmol/L 1 month post-intervention (P<0.001), and there was significant difference (P<0.001) between them. The MAP pre-intervention and 1 month post-intervention were 116.0± 7.0 mmHg and 95.0±9.0 mmHg, and there was significant difference (P<0.001) between them.4. The mean follow up interval was 187 days. Measured Scr and MAP levels separately at 2,3,6,12,16 months post-intervention, the mean Scr levels were 142.3 ±9.9μmol/L,140.8±8.4μmol/L,140.1±10.3μmol/L,143.9±10.0μmol/L,153.1 ±6.2 μol/L, and there were significant differences (P<0.001) as compared with pre-intervention; the MAP were 96.0±10.5 mmHg,94.0±11.4 mmHg,93.0±9.3 mmHg,94.0±9.8 mmHg,97.0±10.1 mmHg, and there were significant differences (P<0.001)as compared with pre-intervention. The comparison of the relative plateau phase between values pre-and post-intervention showed no significant deterioration both in allograft function and BP (Scr,163.2±75.9 vs 162.5±60.5 μmol/L, P> 0.05; MAP,99.0±1.0 vs 96.0±1.0 mmHg, P>0.05).Conclusion:1. TRAS was unrelated to the sources of kidney, gender and anastomoses type. TRAS mainly occurred in 76 to 173 days after KT, and the incidences of the anastomosis stenosis and post-anastomosis stenosis were higher than pre-anastomosis stenosis.2. Ultrasonography showed a sensitivity of 100% and a specificity of 95.5%. Ultrasonography is an effective screening tool for diagnosing TRAS, and it plays an important role in the long-term follow up.3. PTA for TRAS was proved to be safe and effective, and it displayed a low incidence of complication. PTA resulted in significant improvement both in allograft function and blood pressure, and it was also significantly effective in the long-term. |
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