IYSC01 - Sustained Benefit of Endovascular Intervention for Transplant Renal Artery Stenosis

Objectives: Although some authors have shown improvement in allograft function and blood pressure control, the definitive benefits of endovascular treatment for transplant renal artery stenosis (TRAS) are still debated. The aim of this study was to review the experience and outcome of endovascular intervention for TRAS in a high volume center in urban China.

Methods: This is a retrospective review of prospectively collected institutional registry of patients who had undergone renal transplantation at the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2021. Consecutive patients who had TRAS as diagnosed by axial imaging or duplex, and had follow-up up to one year post-procedure were included. Primary outcome was change in glomerular filtration rate (GFR) and serum creatinine at two weeks and one year post-procedure. Secondary outcome included changes in blood pressure, numbers of anti-hypertensive medications, and duplex velocities, as well as complications, re-interventions, allograft survival and mortality throughout the follow-up.

Results: Out of 2230 kidney transplanted, 78 developed TRAS for an incidence of 3.6%. 27 patients received endovascular intervention and had follow-up data available for analysis. 13 patients received angioplasty, and 14 received additional stenting. Table 1 shows the baseline and procedural characteristics. Changes in allograft functions from pre-op, to two weeks and one year post-op were as follows: GFR were 42.7, 61.8, and 76.3ml/min (P < 0.05, Figure 1); the serum creatinine levels were 217.1, 127.6, and 103.4 umol/L (P＜0.05). The changes in the systolic and diastolic blood pressures were 143/87, 125/81, and 120/74mmHg (P < 0.05). The number of antihypertensive medications was reduced from 2.11 at pre-op to 0.93 at one year post-op (P < 0.05). The changes in peak systolic velocity of the treated transplanted renal artery were 234 at pre-op, decreasing to 129 and 118cm/s at two weeks and one year post-op, respectively (P＜0.05). There was no intra- or post-op complications. Allograft survival was 96.3% at one year and 94.4% at three years. Two patients had restenosis and required re-intervention. Two all-cause mortalities occurred during 36.1±21.7 months of follow-up (Table 1).

Conclusions: Endovascular intervention for TRAS are safe and effective, as shown by the improvement in allograft function and blood pressure control at two weeks and one year post-operatively, and is corroborated by the improvement in duplex velocity. Consistent monitoring and follow-up are prudent to detect restenosis and allograft deterioration over the long term.