Renal allograft artery stenosis: results of medical treatment and intervention. A retrospective analysis

Abstract

In a retrospective analysis of 1165 renal transplantations in our center, 65 cases of renal allograft artery stenosis were diagnosed angiographically (prevalence 5.5%). Hypertension was present in all case; a bruit over the allograft and an increase in serum creatinine level were additional reasons for angiography. Shortly after diagnosis of the stenosis, two patients died and two others lost their grafts due to thrombosis. In 24 patients the decision was made not to correct the stenosis. One of these grafts was lost because the stenosis could not be corrected. Medical management of hypertension in these patients resulted in a decrease in diastolic blood pressure from 109±22 to 96±12 mm Hg (P<0.01) 3 months after diagnosis with the use of almost twice as many antihypertensive drugs as at the time of diagnosis (P<0.01). The stenosis was corrected if the angiography showed it to be so severe that it jeopardized renal allograft function or caused uncontrollable hypertension. Only three of nine percutaneous transluminal angioplasty (PTA) procedures resulted in a definitive correction of the stenosis. Surgical intervention was performed in 30 patients, including two patients whose PTAs had proved unsuccessful. Surgery led to graft loss due to thrombosis in 6 of 30 operations (20%), whereas restenosis occurred twice (7%). In three other case (10%), the correction was not successful due to local anatomical variations or concomitant rejection. Successful correction of the stenosis by either PTA or surgical intervention (n=22) resulted in a significant decrease in systolic (171±31 vs 145±27 mm Hg; P<0.01) and diastolic (103±15 vs 89±14 mm Hg; P<0.05) blood pressures 3 months after correction. Concomitantly, a decrease in the number of antihypertensive drugs from 2.1±1.0 to 1.5±1.0 (P<0.01) was achieved. In conclusion, renal allograft artery stenosis could successfully be managed pharmacologically, provided that allograft perfusion was not jeopardized. Successful surgical correction of a stenosis with effective control of hypertension was achieved in 63% of the cases. PTA was less frequently successful but did not cause any graft loss.