An Important Complication After Transplantation: Transplant Renal Artery Stenosis

Year 2020, Volume: 14 Issue: 6, 528 - 530, 30.11.2020

Sevgin Taner , Sebla Güneş Halil Bozkaya Mehmet Arda Kılınç İpek Kaplan Bulut , Ahmet Keskinoğlu Pınar Yazıcı Özkaya Bülent Karapınar Caner Kabasakal

https://doi.org/10.12956/tchd.619562

Abstract

Renal transplantation is a preferred treatment option because of its low long-term mortality and increased quality of life. However, complications after transplantation affect graft and patient survival. Transplant Renal Artery Stenosis (TRAS) is the most common vascular complication following renal transplantation affecting 1-23% of patients. Although it usually causes refractory hypertension, it can also cause graft loss. Although Peripheral Angiography (Digital subtraction angiography) is the gold standard for the diagnosis of TRAS, Doppler USG has become a primary imaging method because it is portable, inexpensive and noninvasive. There are surgical and endoluminal options in the treatment. In this report, a 16-year-old girl who had renal artery stenosis at the 4th month after renal transplantation and underwent percutaneous transluminal balloon angioplasty was reported. She is now in her second year of transplantation without any need for antihypertensive treatment and with preserved graft function.

Keywords

Renal transplantation, Renal artery stenosis, TRAS

Böbrek Nakli Sonrası Önemli Bir Komplikasyon: Transplant Renal Arter Stenozu

Abstract

Renal transplantasyon, düşük uzun dönem mortalite ve artmış hayat kalitesi sağlaması nedeniyle tercih edilen bir tedavi seçeneğidir. Bununla birlikte transplantasyon sonrası gelişen komplikasyonlar nakil böbreğin ve hastanın sağ kalımını etkiler. Transplant Renal Arter Stenozu (TRAS), renal transplant sonrası en sık görülen vasküler komplikasyondur. Hastaların %1-23 ünü etkiler. Çoğunlukla refrakter hipertansiyona neden olsa da greft kaybına da yol açabilmektedir. Renal transplantasyonun ardından ikinci günde görülebileceği gibi operasyondan yıllar sonra da görülebilmektedir. Periferik Anjiografi (Digital subtraction angiography) TRAS tanısı için altın standart olmakla birlikte Doppler USG taşınabilir, ucuz ve noninvaziv olması nedeniyle primer görüntüleme yöntemi haline gelmiştir. Tedavide cerrahi ve endoluminal seçenekler bulunmaktadır. Bu yazıda renal transplantasyon sonrası 4. ayda renal arter stenozu gelişen ve perkutan transluminal balon anjioplasti uygulanarak izlemine nakil sonrası ikinci yılında, antihipertansif tedavi ihtiyacı olmadan ve greft fonksiyonu korunmuş halde devam edilen 16 yaşındaki bir kız hasta bildirildi.

Keywords

Renal transplantasyon, Renal arter stenozu, TRAS

References

• (1) Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999 Dec 2;341(23):1725-30.
• (2) Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000 Mar 2;342(9):605-12.
• (3) Bruno S, Remuzzi G, Ruggenenti P. Transplant renal artery stenosis. J Am Soc Nephrol. 2004 Jan;15(1):134-41.
• (4) Buturovic-Ponikvar J. Renal transplant artery stenosis. Nephrol Dial Transplant., 2003 Jul;18 Suppl 5:v74-7 Review.
• (5) Fervenza FC, Lafayette RA, Alfrey EJ, Petersen J. Renal artery stenosis in kidney transplants. Am J Kidney Dis., 1998 Jan;31(1):142-8.
• (6) Patel NH, Jindal RM, Wilkin T, Rose S, Johnson MS, Shah H, Namyslowski J, Moresco KP, Trerotola SO. Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology. 2001 Jun;219(3):663-7.
• (7) Kobayashi K, Censullo ML, Rossman LL, Kyriakides PN, Kahan BD, Cohen AM. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007 Jul-Aug;27(4):1109-30.
• (8) Fervenza FC, Lafayette RA, Alfrey EJ, Petersen J. Renal artery stenosis in kidney transplants. Am J Kidney Dis. 1998 Jan;31(1):142-8.
• (9) Irshad A, Ackerman S, Sosnouski D, Anis M, Chavin K, Baliga P. A review of sonographic evaluation of renal transplant complications. Curr Probl Diagn Radiol. 2008 Mar-Apr;37(2):67-79. doi: 10.1067/j.cpradiol.2007.06.001.
• (10) AbuRahma AF, Robinson PA, Boland JP, Umstot RK, Clubb EA, Grandia RA, Kennard W, Bastug DF. Complications of arteriography in a recent series of 707 cases: factors affecting outcome. Ann Vasc Surg., 1993 Mar;7(2):122-9.
• (11) Duda SH, Erley CM, Wakat JP, Huppert PE, Lauchart W, Risler T, Claussen CD. Posttransplant renal artery stenosis-outpatient intraarterial DSA versus color aided duplex Doppler sonography. Eur J Radiol., 1993 Feb;16(2):95-101.
• (12) Glicklich D, Tellis VA, Quinn T, et al. Comparison of captopril scan and Doppler ultrasonography as screening tests for transplant renal artery stenosis. Transplantations. 1990;49:217–9.
• (13) Salsamendi J, Pereira K, Baker R, Bhatia SS, Narayanan G. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience. J Radiol Case Rep. 2015 Oct 31;9(10):9-17. doi: 10.3941/jrcr.v9i10.2535.
• (14) Touma J, Costanzo A, Boura B, Alomran F, Combes M. Endovascular management of transplant renal artery stenosis. J Vasc Surg. 2014 Apr;59(4):1058-65. doi: 10.1016/j.jvs.2013.10.072.
• (15) Pappas P, Zavos G, Kaza S, Leonardou P, Theodoropoulou E, Bokos J, et al. Angioplasty and stenting of arterial stenosis affecting renal transplant function. Transplant Proc. 2008 Jun;40(5):1391-6. doi: 10.1016/j.transproceed.2008.04.016.
• (16) Audard V, Matignon M, Hemery F, Snanoudj R, Desgranges P, Anglade MC, et al. Risk factors and long-term outcome of transplant renal artery stenosis in adult recipients after treatment by percutaneous transluminal angioplasty. Am J Transplant 2006 Jan;6(1):95-9.
• (17) Tanimoto S, Serruys PW, Thuesen L, Dudek D, de Bruyne B, Chevalier B, Ormiston JA. Comparison of in vivo acute stent recoil between the bioabsorbable everolimus-eluting coronary stent and the everolimus-eluting cobalt chromium coronary stent: insights from the ABSORB and SPIRIT trials. Catheter Cardiovasc Interv. 2007 Oct 1;70(4):515-23.