THE USE OF EXPANDABLE METAL STENTS IN TRANSPLANT RENAL-ARTERY STENOSIS

The management of resistant transplant renal artery stenosis (TRAS) po ses difficult problems. There is no consensus on the most appropriate course of action if severe stenosis recurs despite repeated percutaneo us transluminal balloon angioplasty (PTA). Expandable metallic vascula r stents have been increasingly successful as an adjunct to PTA in the coronary and peripheral circulation and more recently in the manageme nt of resistant native renal artery stenosis. We report four cases in which such stents were successfully used to treat resistant stenosis i n translant renal arteries. The cases illustrate the range of problems that may be caused by TRAS, from resistant hypertension to impending graft failure. The stents were successfully deployed in all four patie nts. One patient had an acute stent thrombosis successfully treated wi th immediate thrombolysis and two patients required repeat stenting. I n all the cases there was arrest or slowing of previously aggressive r ecurrent TRAS and at the close of follow-up (4-24 months) all patients had adequate stable allograft function, and satisfactory blood pressu re control including the one patient with a significant residual steno sis.