Long-Term Outcomes of Patients Treated with Primary Stenting for Transplant Renal Artery Stenosis: A 10-year Case Cohort Study
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The purpose of the present study was to evaluate graft and patient survival and long-term outcomes of primary endoluminal stenting (PES) as an initial treatment for transplant renal artery stenosis (TRAS).
From December 1999 to March 2010, 744 consecutive patients undergoing renal transplantation were enrolled. Patients were divided into one of two groups: the study group, comprised of 18 patients who underwent PES for TRAS > 60%, and a control group, including the remaining 726 recipients who did not develop TRAS post-transplantation. Primary outcome measures were death-censored graft failure and all-cause mortality. The immediate and long-term effects of PES were evaluated by assessing blood pressure (BP) control and biochemical graft function.
The technical success rate for PES was 100%, and minor complication occurred in only one case (5.6% of the study group). With a mean follow-up of 7.1 ± 3.7 and 6.9 ± 2.4 years in the study and control groups, respectively, 4 patients in the study group and 113 patients in the control group reached the primary outcome (log rank P = 0.418). The reduction in stenosis resulted in immediate improvement in BP control and graft function, which persisted throughout the 6 year follow-up period. Restenosis occurred in only one patient (5.6%), but restenosis was not the cause of graft failure.
This study indicated that both the long-term graft and patient survival were as good in TRAS patients treated with PES as in patients without TRAS. The data also supported the use of PES as an initial treatment for TRAS.
KeywordsBlood Pressure Control Graft Survival Renal Transplant Patient Stenotic Lesion Technical Success Rate
This study was supported by the National Science Council, Taiwan (99-2314-B-040-020- MY2). The authors gratefully acknowledge the assistance of Chun-Huang, Hung, Chung Shan Medical University, with the statistical analysis. The authors also thank Hui-Ching, Tsai, and Chia-Ling, Hong, Chung Shan Medical University Hospital, for their kind assistance in recruiting patients.
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