Renal Artery Stenting May Protect Allografts

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NEW ORLEANS—Renal artery angioplasty and stenting may help improve outcomes in kidney transplant recipients who have stenosis in their transplanted renal artery, researchers reported at the Society of Interventional Radiology's 38th Annual Scientific Meeting.

Robert Lookstein, MD, Chief of Interventional Radiology and Associate Professor of Radiology and Surgery at Mount Sinai Medical Center in New York, and his colleagues conducted a single center retrospective review to examine the long-term effects of stenting in renal transplant patients diagnosed with transplant renal artery stenosis (TRAS) resulting in acute, acute on chronic, or chronic kidney dysfunction. TRAS is a well-recognized complication of a transplanted kidney resulting in renal insufficiency. Studies suggest that the incidence may be as high as 23%. TRAS is associated with worsening refractory hypertension and increased risk of graft loss and it tends to appears three months to two years after transplantation, according to the investigators.

The researchers analyzed data from 41 patients referred for renal transplant revascularization (26 male/63% and 15 female/37%). Among these recipients, 32 (78%) had received a cadaveric kidney and nine (22%) received living-related donor kidneys. The average age at intervention was 57.1 years (range 27-73 years). All patients had hypertension, 41% had diabetes mellitus, 46% had dyslipidemia, and 63% had coronary artery disease.

“We adopted liberal protocols with stents,” Dr. Lookstein told Renal & Urology News. “So far, it is going spectacularly well. We have done more than 1,800 transplants and we have identified 41 patients who have been diagnosed with a significant arterial stenosis in their transplanted renal artery. All 41 patients were successfully treated by a single stent. We have a medium follow-up of approximately one year and we have found that kidney function improved 50%.”

All patients received antiplatelet therapy for 90 days following initial intervention. The initial technical success rate was 100%.

The survival rate of the kidney transplant itself at one year is more than 90%, the re-intervention rate is approximately 5%, and the overall survival rate for the cohort is approximately 98%, Dr. Lookstein said. The findings highlight the use of interventional radiology for treating an at-risk population with end-stage renal disease who have been lucky enough to obtain a kidney transplant and have a major complication, he said.

Only one of the 41 patients required re-intervention and no patient required re-transplantation. The 41 patients had a mean estimated glomerular filtration rate (eGFR) of 27.87 mL/min/1.73 m2 at the time of diagnosis of TRAS. At one year after stent placement, the researchers observed significant improvements in eGFR.

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