Renal arterial stenosis in renal allografts: Retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty

PURPOSE: To determine the predisposing factors to transplant renal arterial stenosis (TRAS) and assess the outcome of percutaneous transluminal angiop lasty (PTA) as the primary treatment. MATERIALS AND METHODS: Of 831 renal allograft recipients (584 cadaveric, 24 7 living related) between January 1991 and December 1998, 72 had hypertensi on and/or renal dysfunction. All 72 underwent arteriography, and their medi cal charts were retrospectively reviewed. RESULTS: Prevalence of TRAS was 3.1% (26 of 831). Technical success rate of PTA was 94% (16 of 17), and clinical success rate was 82% (14 of 17). Thos e with renal dysfunction had a mean pre-PTA creatinine value of 2.6 mg/dL ( 230 mu mol/L) +/- 0.5 (SD) versus a 1-week post-PTA value of 1.7 mg/dL (150 mu mol/L) +/- 0.3 (P < .001). Of those with hypertension, all but one had substantial improvement in mean diastolic blood pressure. At 26.9 months me an follow-up in 16 patients with successful PTA, two stenoses reoccurred, a nd two grafts were lost to chronic rejection. TRAS was present in 14 of 45 end-to-side anastomoses and 12 of 27 end-to-end anastomoses (P = .31), and TRAS was more prevalent in cadaveric grafts (24 of 584) than in living rela ted grafts (two of 247). In cadaveric grafts, the mean cold ischemia time w as 29.0 hours +/- 6.9 in those with TRAS (n = 24), as compared with 25.5 ho urs +/- 8.1 in those with no TRAS (n = 39; P =.35). Seven of 17 patients wi th acute rejection and six of 35 with chronic rejection had TRAS. CONCLUSION: Primary treatment of TRAS with PTA has good intermediate-term r esults. TRAS is more prevalent in cadaveric allografts with long cold ische mia time.