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Post-Transplant Renal Artery Stenosis: Impact of Therapy on Long-Term Kidney Function and Blood Pressure Control

1996; Lippincott Williams & Wilkins; Volume: 155; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(01)66030-0

1527-3792

Bashir R. Sankari, Michael Geisinger, Margaret G. Zelch, Ben H. Brouhard, Robert J. Cunningham, Andrew C. Novick,

Neurological Complications and Syndromes

No AccessJournal of UrologyClinical Urology: Original Article1 Jun 1996Post-Transplant Renal Artery Stenosis: Impact of Therapy on Long-Term Kidney Function and Blood Pressure Control Bashir R. Sankari, Michael Geisinger, Margaret Zelch, Ben Brouhard, Robert Cunningham, and Andrew C. Novick Bashir R. SankariBashir R. Sankari More articles by this author , Michael GeisingerMichael Geisinger More articles by this author , Margaret ZelchMargaret Zelch More articles by this author , Ben BrouhardBen Brouhard More articles by this author , Robert CunninghamRobert Cunningham More articles by this author , and Andrew C. NovickAndrew C. Novick More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66030-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the long-term outcome of different treatment methods for transplant renal artery stenosis. Materials and Methods: Outcome data for 23 patients with transplant renal artery stenosis treated during a 16-year period were reviewed and analyzed. Results: There was a higher incidence of renal artery stenosis in cadaveric donor kidneys compared to living donor kidneys (2 percent versus 0.3 percent, p less than 2), and in cadaveric kidneys from pediatric donors less than 5 years old compared to those from adults (13.2 percent versus 1.3 percent, p less than 0.01). Six patients underwent primary medical treatment for renal artery stenosis, with a successful outcome in 4 (mean followup plus or minus standard error 57 plus/minus 22 months) and failure in 2. Of the patients 16 were treated with percutaneous transluminal angioplasty, including 12 who were cured or improved with respect to hypertension (followup 44.7 plus/minus 7.6 months). Five patients underwent surgical revascularization for renal artery stenosis with postoperative improvement of hypertension (followup 18.8 plus/minus 11.6 months). Overall, 21 of 23 patients (91 percent) were treated successfully for transplant renal artery stenosis with cure or improvement of associated hypertension. Posttreatment renal function was stable or improved in 18 patients, while renal function deteriorated due to parenchymal disease in 3. Conclusions: Most patients with transplant renal artery stenosis can be treated successfully. Percutaneous transluminal angioplasty is the initial interventive treatment of choice for high grade renal artery stenosis. Surgical revascularization is indicated if percutaneous transluminal angioplasty cannot be done or is unsuccessful. References 1 : Relationship of renal transplantation to hypertension in end-stage renal failure. Arch. Intern. Med.1978; 138: 1236. Google Scholar 2 : Late hypertension following renal allotransplantation. Clin. Nephrol.1979; 11: 202. Google Scholar 3 : Hypertension in renal transplant recipients on cyclosporin A and corticosteroids and azathioprine. Transplant. Proc.1982; 14: 597. Google Scholar 4 : Causes of death after kidney transplantation. J.A.M.A.1983; 250: 49. Google Scholar 5 : Etiology and pathogenesis of hypertension following renal transplantation. Nephron1986; 42: 102. Google Scholar 6 : Surgical correction of posttransplant renovascular hypertension. Ann. Surg.1980; 192: 639. Google Scholar 7 : Treatment of renal artery stenosis after renal transplantation. Transplant. Proc.1987; 19: 3600. Google Scholar 8 : Percutaneous transluminal angioplasty. The procedure of choice in the hypertensive renal allograft recipient with renal artery stenosis. Transplantation1987; 43: 29. Google Scholar 9 : Renal artery stenosis after renal transplantation. Ann. Vasc. Surg.1988; 2: 155. Google Scholar 10 : Transplant renal artery stenosis. Transplantation1989; 48: 580. Google Scholar 11 : Hypertension following renal transplantation. Causative factors and therapeutic implications. J.A.M.A.1979; 241: 1128. Google Scholar 12 : Hypertension due to renal artery stenosis in transplanted kidneys. Ann. Surg.1975; 181: 604. Google Scholar 13 : Renal allograft artery stenosis. Amer. J. Surg.1977; 134: 400. Google Scholar 14 : Arterial stenosis complicating renal allotransplantation in man: a study of 38 cases. Ann. Surg.1975; 181: 283. Google Scholar 15 : Anastomotic line renal artery stenosis after transplantation. J. Urol.1986; 135: 1159. Link, Google Scholar 16 : Diagnosis and management of arterial stenosis causing hypertension after successful renal transplantation. J. Urol.1976; 115: 639. Link, Google Scholar 17 : Renal artery stenosis after renal transplantation. Amer. J. Surg.1976; 131: 653. Google Scholar 18 : Homotransplant renal artery stenosis. Surgery1975; 77: 53. Google Scholar 19 : Arteriography of renal transplantation. Clin. Rad.1987; 38: 239. Google Scholar 20 : Posttransplant renal artery stenosis: angiographic study in 32 children. AJR1987; 148: 487. Google Scholar 21 : Percutaneous transluminal dilation in renal transplant arterial stenosis. Transplantation1980; 30: 440. Google Scholar 22 : Percutaneous transluminal angioplasty of renal transplant artery stenosis. Clin. Rad.1987; 38: 235. Google Scholar 23 : The mechanism of balloon angioplasty. Radiology1980; 135: 565. Google Scholar 24 : Hazard of percutaneous transluminal dilation in renal transplant arterial stenosis. Arch. Surg.1981; 116: 1225. Google Scholar 25 : Stenting of the iliac arteries with the Palmaz stent: experience from a multicenter trial. Cardiovasc. Intervent. Rad.1992; 15: 291. Google Scholar 26 : Renal artery stenosis following transplantation: etiology, diagnosis, and prevention. Surgery1978; 84: 595. Google Scholar From the Departments of Urology, Radiology and Nephrology, Cleveland Clinic Foundation, Cleveland, Ohio.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byHALIMI J, AL-NAJJAR A, BUCHLER M, BIRMELE B, TRANQUART F, ALISON D and LEBRANCHU Y (2018) TRANSPLANT RENAL ARTERY STENOSIS: POTENTIAL ROLE OF ISCHEMIA/REPERFUSION INJURY AND LONG-TERM OUTCOME FOLLOWING ANGIOPLASTYJournal of Urology, VOL. 161, NO. 1, (28-32), Online publication date: 1-Jan-1999. Volume 155Issue 6June 1996Page: 1860-1864 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Bashir R. Sankari More articles by this author Michael Geisinger More articles by this author Margaret Zelch More articles by this author Ben Brouhard More articles by this author Robert Cunningham More articles by this author Andrew C. Novick More articles by this author Expand All Advertisement PDF downloadLoading ...