Transplant renal artery stenosis (TRAS) has been an increasingly recognized complication post kidney transplantation, and a potentially reversible cause for hypertension and allograft dysfunction. This retrospective case series aims to describe five cases of upstream native common iliac artery stenosis (CIAS), leading to similar clinical presentations as TRAS, with resistant hypertension and graft dysfunction.

Methods: Five cases were identified over a period of 15 years from a single Canadian centre; baseline characteristics and known risk factors for TRAS were abstracted from the electronic medical record, as well as blood pressure readings, medications and laboratory parameters pre and post intervention.

Results: Three of the five cases were deceased donor kidney transplants, with the average time from transplantation to diagnosis of CIAS of 6.3 years. The culprit stenotic lesions were proximal to the transplanted renal artery in all cases, located at the common iliac artery or at the aortic bifurcation. All cases were angioplastied, and four cases were stented. One patient who was dialysis dependent for 2 weeks recovered completely to baseline eGFR of 61 ml/min per 1.73m2 post angioplasty procedure. In the remaining four cases the mean improvement in eGFR was 26.5 ml/min per 1.73m2 (4.5 – 57.5). Systolic blood pressure was reduced by a mean of 20 mmHg, and diastolic of 4 mmHg. These improvements in graft function and blood pressure were maintained over a follow up period of up to 8.3 years, comparable to longest follow up available data for TRAS of 8 years post initial angioplasty procedure. The number of antihypertensives prescribed post angioplasty procedure improved in half of the cases, with an average of two fewer medications.

Conclusion: This case series describes a rarely recognized etiology of graft dysfunction – Common Iliac Artery Stenosis. Similar to TRAS, intervention for common iliac artery stenosis results in clinically significant improvement in both graft function and blood pressure. Modern transplant techniques may have reduced the incidence of classically described TRAS at the anastomotic site. The gradual increase in age, comorbidities, and atherosclerotic arterial disease burden of transplant recipients over time may also be a major factor in upstream native vessel stenosis. Further research is required to ascertain the clinical factors predictive of developing CIAS in order to implement methods for early detection and prevention.

CITATION INFORMATION: Christie E, Campbell P, Wen K. Common Iliac Artery Stenosis: An Often Overlooked Cause of Graft Dysfunction. Am J Transplant. 2016;16 (suppl 3).

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