Transplant renal artery stenosis (TRAS) is a common complication after
transplantation and is an important cause of graft dysfunction. Damag
e from graft rejection, trauma, and atherosclerosis have been implicat
ed as possible causes, We reviewed all 917 patients transplanted in ou
r unit since 1978 to study the prevalence, clinical features, and poss
ible causes of TRAS, Seventy-seven patients with TRAS were identified.
The detected incidence was 2.4% before the introduction of color dopp
ler ultrasonography (CDU) and rose to 12.4% after CDU was introduced i
n 1985, giving an overall incidence of 8.4% during a mean follow-up pe
riod of 6.9 years, The TRAS group was compared with a control group of
77 transplanted patients matched for age, year of transplant, sex, an
d number of previous grafts, Mean ages for the study and control group
s were 43.6+/-15 and 44.8+/-13.7 yr. A total of 25% of cases of TRAS w
ere diagnosed within the first 8 wk of transplantation and in 60% with
in the first 30 wk (median=23 wk). All patients were treated with angi
oplasty, 28 patients had recurrence of TRAS requiring multiple angiopl
asties (maximum 5) and 1 went on to have surgery, Angioplasty resulted
in a significant fall in plasma creatinine, Patient and graft surviva
l were significantly worse in the TRAS group: 69% vs, 83% (P<0.05) and
56% vs. 74% (P<0.05) (TRAS vs. Control), respectively, There was a si
gnificantly higher incidence of rejection, especially cellular rejecti
on in the TRAS group, 0.67 vs, 0.35 episodes per patient (P<0.01) (TRA
S vs. Control), Recurrence but not occurrence of TRAS was associated w
ith the use of cyclosporine.