Background
Transplant renal artery stenosis (TRAS) is an oft-unrecognized and potentially reversible cause of hypertension, volume overload, and allograft dysfunction in the renal transplant recipient. Definitive diagnosis and management of hemodynamically significant TRAS rest on the use of diagnostic angiography and appropriate endovascular intervention (EVI). We report herein our experience with the use of drug-eluting stents (DES) for EVI to eligible transplant renal arteries with either reference vessel diameters less than 5 mm or restenotic disease.
Methods
Eleven patients were diagnosed with significant TRAS meeting these criteria and underwent EVI with placement of 19 DES for separate lesions. Demographics: male/female, 7:4; age, 53±10 years; all recipients of deceased donor kidneys. All had undergone induction therapy followed by rapid steroid withdrawal and maintenance immunotherapy with tacrolimus and mycophenolate mofetil (MMF). All patients underwent color duplex sonography with criteria for severe TRAS established prior to angiography. At the time of angiography, mean serum creatinine was 3.36±0.45 mg/dl with a mean blood pressure of 154/82 mmHg on two to four antihypertensive agents; six of 11 patients had significant pedal edema. Five patients had dual transplant renal arteries and two patients had restenotic disease. DES usage included nine zotarolimus- (ZES), nine everolimus- (EES), and one sirolimus-eluting stent (SES).
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