TRANSPLANT RENAL-ARTERY STENOSIS IN 77 PATIENTS - DOES IT HAVE AN IMMUNOLOGICAL CAUSE

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.