Abstract
Background
Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing kidney transplantat, with a reported incidence ranging from 1% to 23%. Clinically important TRAS is associated with refractory hypertension, graft dysfunction and increased peak systolic velocity (PSV) above 200 cm/s. Percutaneous intervention (PI) of TRAS with or without stent is widely accepted as a viable and safe treatment option.
Purpose
To evaluate blood pressure and renal function in patients with TRAS undergoing PI in the following year.
Methods
Between January 2007 and December 2014, 310 patients with suspected TRAS underwent consecutive angiography. Of these, 173 presented significant stenosis (>60%) and were submitted to PI. Endpoints were systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (Scr), number of blood pressure medications and PSV with one month and one year post intervention.
Results
The mean age was 42.89±15.03 years, 78% of the population were male, 84% received kidneys from decesed donors, 94% having received a stent. The angiographic success and complication rates were 98% and 8,4% respectively. 98.7% were on blood pressure medications with 2.13±1.05 drugs/patient. Pre-intervention values of SBP, DBP and Scr were 152.8±25.28 mmHg, 92.67±16.43 mmHg and 3.04±2.75 mg/dL, respectively. After 1 month, there was a significant reduction in SBP (138.34±19.71; p<0.0001), DBP (82.52±12.2; p<0.0001) and Scr (2.13±1.39 mg/dl, p<0.0001). Following 01 year, SBP, DBP and Scr were 133.55±17.51, p<0.0001; 83.51±11.23, p<0.0001 (Figure); and Scr 1.94±1.09 mg/dL, p<0.0001 respectively. There was a significant reduction in post-intervention PSV when compared to baseline results (422.2±148.8 vs. 237.1±104.6 m/s, p<0.0001). There was no significant difference in the number of blood pressure medications pre and post intervention (2.13 vs 2.05; p=0.68).
Evolution of Blood Pressure
Conclusion
PI with stent of TRAS was effective in improving blood pressure and renal function levels on month 1 and on year 1 with a low rate of complications.
Renal intra-arterial heparin flushing for blood pressure control in refractory hypertension: A new method to salvage the unsalvageable renal artery stenosis
